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THE  LIBRARIES 

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ËHÛïlffûDfiûïlfnnlfîmlfrifïlfrL^ 


Nervous  and  Mental  Disease  Monograph  Series  No.  30 


THE  INTERNAL  SECRETIONS 


AND  THE 


NERVOUS  SYSTEM 


BY 


DR.  M.  LAIGNEL-LAVASTINE 

/''/  PARIS 


Authorized  Translation  by 
DR.  F.  T.  ROBESON 

New  York 


NEW  YORK  AND  WASHINGTON 

NERVOUS  AND   MENTAL   DISEASE   PUBLISHING 

COMPANY 


1919 


Reprinted  with  the  permission  of  the  Original  Publisher 

JOHNSON   REPRINT  CORPORATION     JOHNSON  REPRINT  COMPANY  LTD. 
11 1  Fifth  Avenue,  New  York,  NY.  10003     Berkeley  Square  House,  London,  W1X6BA 


L/4- 


First  reprinting  1970,  Johnson  Reprint  Corporation 
Printed  in  the  United  States  of  America 


Copyright,  1919  by 

Nbevous  and  Mental  Disease  Publishing  Company 

3617  loth  St.    N.  W.,  Washington,  D.  C. 


sa 


I 

03 


TRANSLATOR'S   PREFACE 

In  the  original  French  "  The  Internai  Secretions  and  the  Nervous 
System,"^  by  Prof.  Laignel-Lavastine,  is  a  classic.  The  translation 
is  crude  and  without  literary  merit,  and  its  only  virtue  is  that  a 
sincere  attempt  has  been  made  to  preserve  its  scientific  value. 

As  proper  innervation  of  the  internal  organs  is  necessary  for 
health,  and  considering  that  there  is  an  intimate  relationship  be- 
tween the  ductless  glands  and  the  nervous  system,  the  proper  under- 
standing of  the  subject  is  not  only  of  interest  to  the  neurologist  but 
to  the  general  practitioner  as  well. 

Organotherapy  dates  back  to  remote  ages,  as  Dr.  Diner  has 
stated  in  his  introduction.  The  Chinese  treated  obesity  with  prep- 
arations made  from  canine  orchitic  extracts  and  heart  disease  and 
epilepsy  with  dried  and  powdered  frogs  and  nevrts.  It  has  been 
shown  by  Abel's  investigations  that  the  skins  of  these  animals  con- 
tain an  appreciable  amount  of  adrenalin  owing  to  the  presence  of 
cutaneous  adrenals.  To-day  suprarenal  extract  is  used  in  certain 
forms  of  heart  disease  and  epilepsy  with  excellent  results.  More- 
over we  have  no  other  adequate  treatment  for  eunuchoid  obesity 
than  the  administration  of  orchitic  extracts.  It  would  seem  that 
modern  medical  knowledge  is  not  the  only  healing  art  that  was  ever 
practiced.  Empirics  they  were  perhaps,  but  be  that  as  it  may 
"  There  were  Kings  before  Agamemnon." 

If  the  renewed  interest  in  endocrinology  has  done  nothing  else 
for  the  art  of  medicine  it  has  shown  the  utter  futility  of  regarding 
physiology  and  pathology  en  masse.  It  is  the  individual  and  the 
study  of  the  individual  that  is  of  supreme  importance.  Everyone 
has  his  own  proper  physiology  and  his  own  proper  pathology  as 
well.  Following  along  their  lines  his  life  takes  its  course.  That 
there  are  a  broad  common  physiology  and  pathology  none  can  deny, 
but  that  each  individual  has  his  own  physiological  and  pathological 
variant  is  also  not  to  be  questioned.  There  is  no  truer  saying  than 
that  "  what  is  one  man's  meat  is  another  man's  poison,"  and  it  is  the 
disregard  of  this  fact  that  has  hampered  the  advance  of  medical 

1  Article  written  in  July,  1914,  for  the  Congress  at  Berne,  which  did  not 
take  place  on  account  of  the  War.  I  here  publish  the  entire  text,  just  as  it 
was  given  to  the  Revue  de  Médecine  in  July,  1914. 

iii 


IV  THE   INTERNAL   SECRETIONS   AND 

diagnosis  and  therapeusis  for  years.  Whether  it  comes  under  the 
heading  of  mechanistic  physiology  or  vitalistic  physiology  it  is  the 
individual  physiology  that  has  to  be  carefully  analyzed  and  con- 
sidered before  a  proper  appreciation  of  health  and  disease  can  be 
arrived  at.  Endocrinology  has  taught,  and  is  still  teaching  us  to 
analyze  our  cases  by  close  clinical  observation  and  research.  In 
many  ways  Nature  is  a  kind  mistress  after  all,  and  even  her  misfits 
are  frequently  granted  a  modus  vivendi  which  can  only  be  appre- 
ciated by  the  right  kind  of  clinical  study.  In  the  analysis  of  endo- 
crinal  disease  a  slipshod  method  is  worse  than  useless.  The  family 
history,  the  previous  history,  the  present  history,  the  personal  idio- 
syncrasies, likes  and  dislikes,  physical  make-up  and  appearance,  in 
fact  all  that  concerns  the  individual  must  be  elicited,  weighed  and 
balanced  even  to  the  most  minute  detail.  In  this  way  alone  can 
success  be  arrived  at. 

It  would  be  presumptuous  in  me  to  enter  into  detailed  descrip- 
tions of  methods  of  endocrinological  research  which  has  been 
furthered  by  American  observers.  When  the  time  is  ripe  for  the 
publication  of  well-authenticated  facts  on  the  subject  they  will  ap- 
pear in  proper  form.  I  may  be  pardoned,  however,  in  stating  here 
certain  conclusions  which  have  been  arrived  at,  and  which  have 
been  confirmed  time  and  time  again. 

A.  Briefly  stated  the  life  of  every  individual  is  dominated 
largely  if  not  wholly  by  his  ductless  gland  chain. 

B.  Certain  of  these  glands  assume  a  preponderating  influence 
on  the  morphology,  physiology  and  pathology  of  the  individual. 

C.  Certain  tropisms  are  existent,  so  that  we  have  the  pituitary, 
thyroidal,  adrenal,  etc.,  type  of  individual. 

D.  Certain  diseases,  both  of  an  acute  and  constitutional  char- 
acter, are  welded,  as  it  were,  with  the  glandular  tropisms,  and  belong 
to  them,  and  are  part  of  their  distinctive  pathology,  either  func- 
tional or  organic.  This  is  not  only  true  of  acromegaly,  Basedow's 
disease  or  Addison's  disease,  but  of  many  other  diseases  as  well. 

E.  The  glandular  influence  having  so  much  to  do  with  morphol- 
ogy, the  physical  make-up  of  the  individual  gives  marked  evidence 
of  the  glandular  constellation  under  which  he  lives  and  has  his 
being, 

F.  Within  certain  limits  if  the  previous  history  of  the  individual 
be  accurately  known,  his  physical  appearance  can  be  approximately 
described,  and  his  physiological  and  future  pathological  states  can 
be  predicted. 


THE    NERVOUS   SYSTEM  V 

Some  of  these  conclusions  need  no  defense,  and  will  be  acceded 
to  by  all  who  have  given  the  subject  even  a  moment's  consideration, 
while  others  will  not  be  admitted  by  all  endocrinologists. 

The  results  obtained  in  the  experimental  feeding  of  tadpoles  are 
very  significant.  The  small  amphibia  that  were  fed  on  thyroid 
gland  developed  into  tiny  frogs  described  as  "  petit  vieux,"  and  those 
that  were  fed  on  thymus  grew  into  enormous  tadpoles  or  "grand 
enfants."  This  experiment  proves  to  some  extent  at  least  why 
taking  two  individuals  of  the  same  age,  one  may  look  like  a  prema- 
ture old  man,  and  the  other  have  the  appearance  of  unwarranted 
juvenility. 

The  physiology,  psychology  and  pathology  of  the  two  will  follow 
the  thyroidal  and  thymic  influences  that  have  had  such  a  marked 
bearing  on  their  morphology. 

Take  for  example  the  dominion  of  the  pituitary  gland  on  certain 
types  of  body  structure.  Giantism  in  youth,  acromegaly  in  adult 
life  and  shrinking  in  old  age.  There  are  small  pituitary  types  as 
well.  The  dominating  influence  of  the  pituitary  makes  for  femi- 
nism in  the  male,  just  as  the  dominating  influence  of  the  adrenals 
makes  for  masculinity  in  the  female.  The  thyroidal  individual  has 
his  marked  personal  characteristics — his  bright  intelligent  eye,  his 
good  clean  teeth,  his  temperamental  attitude  toward  life,  his  free- 
dom from  infectious  disease  except  measles  and  typhoid  and  his 
tendency  towards  intestinal,  certain  forms  of  cardio-vascular  and 
neurotic  disturbances.  The  pituitary  individual,  easily  recognized 
by  his  structural  make-up,  has  his  own  peculiarities.  He  is  musical, 
has  an  abnormally  acute  sense  of  rhythm  and  is  prone  to  diseases 
attended  by  periodicity  and  to  syphilis  (Charcot  joint — a  local 
acromegaly).  The  adrenal  individual  has  his  strong  masculinity, 
his  tendency  to  hypertrichosis  and  pigmentosis,  his  liability  to  diph- 
theria, to  hyperchlorhydria,  to  hypertension,  to  certain  forms  of 
pulmonary  disease,  to  hernia  and  varicocele.  These  master  types 
have  their  variants  depending  upon  the  influences  of  the  other 
glands,  especially  marked  in  the  gonads.  The  endocrine  system  has 
been  well  described  as  the  ductless  gland  chain,  and  it  is  impera- 
tive to  realize  that  every  link  counts.  The  clinical  picture  is  never 
a  simple  one. 

It  will  be  through  endocrinological  study  and  investigation  that 
we  will  come  to  a  better  understanding  of  humanity.  We  will  see 
how  within  certain  broad  lines  the  life  of  the  individual  takes  its 
course.     We  will  understand  perhaps  what  the  world  calls  Fate. 

F.  T.  Robeson 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons  (for  the  Medical  Heritage  Library  project) 


http://www.archive.org/details/internalsecretioOOIaig 


TRANSLATOR'S   INTRODUCTION 

"Every  man,  from  the  highest  to  the  lozvest  station,  ought  to 
zvarm  his  heart  and  animute  his  endeavors  with  the  hope  of  being 
useful  to  the  zvorld,  by  advancing  the  art  which  is  his  lot  to  exercise; 
and  for  tftnt  end  he  must  necessarily  consider  the  whole  extent  of  its 
application,  and  the  whole  weight  of  its  importance." — Johnson. 

In  making  the  writings  of  Laignet-Lavastine  accessible  to  those 
not  familiar  with  the  French  language,  the  translator  has  certainly 
hearkened  to  the  admonition  quoted  above. 

The  importance  of  the  internal  secretions,  both  as  etiological 
factors  and  as  remedial  agents,  is  being  recognized  more  and  more 
and  anything  which  adds  to  our  understanding  of  this  highly  com- 
plex subject  should  be  welcomed  with  open  arms  by  the  medical 
profession. 

Organotherapy  or  the  use  of  animal  matter  in  the  treatment  of 
disease  is  not  by  any  means  a  new  addition  to  the  medical  arma- 
mentarium. It  is  the  intelligent  interpretation  of  the  symptom- 
complexes  arising  from  dysfunction  of  the  endocrine  glands  and  the 
rational  application  of  the  secretions  of  these  glands  which  anew 
engages  the  attention  of  the  medical  research  worker  and  clinician 
alike. 

The  indirect  appHcation  of  animal  tissues  and  organs  to  the 
treatment  of  disease  finds  its  first  expression  at  the  sacrificial  altar. 

In  gray  antiquity,  medicine  and  religion  went  hand  in  hand. 
God  only  could  cure  diseases  and  those  of  his  representatives  who 
were  close  to  him  in  his  service,  the  high  priests,  were  empowered  to 
execute  his  will  in  this  direction  as  well  as  in  religious  matters. 
History  records  that  as  far  back  as  2000-3000  B.C.  the  treatment 
of  disease  was  in  the  hands  of  the  priests  in  Egypt.  In  Greece  the 
Asclepiades,  the  priests  of  the  temple  of  Asclepias,  were  entrusted 
with  this  important  function.  And  Moses  transferred  to  the  priests 
the  knowledge  of  medicine  which  he  accumulated  in  Egypt. 

The  Hebrew  literature,  while  replete  with  medical  information, 
gives  but  scant  evidence  of  animal  therapy.  No  doubt  the  term 
"unclean"  which  is  so  frequently  employed  as  a  prohibitive  injunc- 
tion with  reference  to  food,  hygiene  and  other  matters,  comes  into 
play  here  and  accounts  for  the  scant  use  of  animal  matter  for  medic- 


Vni  THE   INTERNAL   SECRETIONS   AND 

inal  purposes.  In  Joma,  VIII,  6,  we  find  that  "  One  bitten  by  a 
mad  dog  was  given  the  liver  of  the  dog  as  an  antidote  "  and  the  use 
of  small  doses  of  urine  is  passingly  mentioned  in  another  section, 
but  whether  to  be  taken  internally  or  applied  externally  is  not  clearly 
stated. 

However,  if  we  cast  our  eye  on  the  medical  literature  of  other 
nations  and  peoples,  we  find  no  lack  of  evidences  of  animal  therapy. 
Without  making  any  attempt  at  chronological  arrangement,  I  will 
merely  cite  a  few  instances. 

The  Papyrus  Eberus  recommends:  human  brain,  half  with 
honey  and  half  dried,  as  a  remedy  against  inflammation  of  the  eyes. 
Dioscorides,  first  century  of  present  era  (II,  21),  recommends  the 
fried  brain  of  the  hare  as  a  good  remedy  for  the  cure  of  "  Tremor, 
Convulsions,  etc."  Sextus  Platonicus  (330  A.D.)  recommends  the 
fried  brain  of  the  hare  given  internally  to  aid  dentition  in  children. 
Celsus  (II,  31,  34)  as  well  as  Plinius  (XXVIII,  60)  suggest  the 
use  of  brain  of  the  hare  for  urinary  incontinence.  And  Plinius. 
Dioscorides  and  others  advise  the  use  of  brain  of  different  animals 
for  the  treatment  and  cure  of  epilepsy. 

The  liver  also  plays  an  important  part  in  the  materia  medica  of 
antiquity.  Besides  the  quotation  previously  mentioned,  we  find  that 
Hippocrates  speaks  of  the  benefit  to  be  derived  from  the  use  of 
sheep's  liver  and  of  goat's  liver  in  the  treatment  of  diseases  of  the 
uterus.  Plinius  considers  human  liver  as  indicated  to  combat  epi- 
lepsy ;  and  Scribonius  Largus  uses  "  a  piece  of  liver  from  a  suffo- 
cated gladiator"  for  the  same  purpose  (epilepsy). 

Herophilus  (300  B.C.)  employs  liver  in  cases  of  dysmenorrhea 
and  metrorrhagia,  as  does  Plinius,  who  also  finds  it  useful  against 
cough,  tachycardia  and  ascites. 

Bile  is  employed  by  Hippocrates  in  gynecological  practice  in 
the  form  of  suppositories  to  combat  sterility,  prevent  abortions  and 
to  ameliorate  dysmenorrhea  and  amenorrhea.  Plinius  uses  bile  as 
a  cathartic  internally  and  applies  it  externally  in  treating  diseases  of 
the  eye  and  to  remove  warts.  Sextus  Platonicus  treats  dizziness, 
epilepsy  and  asthma  by  internal  medication  with  bile.  Orchitic 
substance  is  mentioned  by  Susruta  (400-600  B.C.)  for  the  treat- 
ment of  obesity. 

Particularly  rich  in  information  on  the  subject  of  organotherapy 
are  the  writing  of  Dioscorides.  Thus  we  find  that  the  blood  of 
doves  and  wild  hens  is  a  valuable  remedy  against  recent  injuries  of 


THE    NERVOUS   SYSTEM  IX 

the  eyes,  against  hemorrhages  and  in  many  other  pathological  condi- 
tions. The  blood  of  doves  is  especially  valuable  in  hemorrhages  of 
the  brain,  while  the  blood  from  other  animals,  such  as  goat,  sheep, 
rabbit,  etc.,  fried  in  a  pan  and  taken  internally,  cures  or  stops  dysen- 
tery. Blood  from  land-turtles  is  a  sure  cure  for  epilepsy.  Men- 
strual blood  prevents  conception  when  painted  in  a  circle  around  the 
body  (abdomen?)  or  if  one  steps  over  it  (blood).  When  rubbed 
in  as  a  liniment  it  removes  podagra  and  roseola.  Feces  of  different 
animals  also  finds  manifold  uses.  So  for  instances  it  is  indicated 
to  reduce  inflammations,  remove  scrophula  and  gland-enlargements, 
correct  prolapsus  uteri,  chase  away  mosquitoes,  aid  menstruation 
and  to  promote  abortion. 

Frogs  prepared  with  oil  and  salt  are  a  sure  antidote  for  serpent's 
bite.  Incidentally  they  cure  painful  tendons  and  stop  bleeding  when 
applied  externally  after  burning  and  powdering  them. 

Testicle,  dried  and  finely  powdered,  taken  in  wine  is  also  used 
as  antidote  for  serpents'  bites  but  the  beaver's  testicle  is  especially 
valuable  to  help  in  bringing  on  the  menstrual  flow,  aid  abortion  and 
promote  expulsion  of  retained  placenta.  Incidentally  it  also  finds 
its  use  in  relieving  cramps,  convulsions  and  nervousness.  Crabs, 
especially  river-crabs,  when  boiled  with  honey  are  recommended  for 
the  removal  of  carcinomatous  growths,  and  when  boiled  with  meat- 
soup  are  indicated  in  the  treatment  of  phthisis  pulmonalis.  Sea- 
crabs  may  be  used  for  the  same  purposes  but  are  less  efficient. 
Lungs,  especially  fox's  lungs,  dried  and  taken  internally  cure  asthma. 
And  finally  Dioscorides  recommends  urine  for  a  number  of  diseases. 
So  for  instance  is  one's  own  urine  good  against  serpents'  bites  ;  that 
from  a  mad  dog  against  the  bite  of  the  dog,  while  the  urine  of  an 
innocent  boy,  taken  internally,  cures  orthopnea.  Urine  is  also  em- 
ployed in  various  forms  against  eruptions,  dysmenorrhea,  pams  in 
uterus,  earache  and  urinary  calculus. 

BIBLIOGRAPHY 

Bcrendes,  J.    Des  Pedonius  Dioslcurides  Arzneimittellehre. 
Bcrgel,  Dr.  Joseph.    Die  Medizin  der  Talmudisten. 
Carmoly,  E.    History  of  the  Jewish  Physicians. 
Ebstein,  W.    Die  Medizin  im  Neuen  Testamente  und  im  Talmud. 
Fattaciolli,  Joseph.     L'Organothérapie  humaine  en  Thérapeutique. 
Fricdenwald,  A.    Jewish  Physicians  and  their  contributions  to  Medicine,  etc. 
Fuchs,  Lconhard.    Hippocrate's  siimthche  Wcrkc. 
GriJlingius,  Ph.     Tractatus  Novus,  etc. 

Newton,  Richard  Cole.     President's  Address.     Medical  Record,  N.  Y.,  IV, 
7,  1906. 


X  THE   INTERNAL   SECRETIONS   AND 

Preuss,  Dr.  Julius.    Biblisch-Talmudisch  Medizin. 

Sharp,  William.    Organotherapy. 

Stebbins,  Nathaniel  D.    Scripture  Evidence  of  a  General  System  of  Medical 

Practice. 
Steinschneider,  M.    Schriften  iiber  Medizin  in  Bibel  und  Talmud. 
Wolzendorff,  Gustav.    Gesundheitspflege  und  Medizin  der  Bibel. 
Winkler,  L.    Animalia  als  Arzneiraittel. 
Yellin,  David,  and  Abrahams,  Israel.    Marmonides. 


AUTHOR'S    INTRODUCTION 

The  relations  of  the  internal  secretions  and  the  nervous  system 
constitute  an  immense  subject,  which  requires  to  be  classified  and 
condensed  in  as  short  a  report  as  this  to  escape  the  penalty  of 
remaining  under  vague  generalities. 

The  most  recent  and  important  work  issued  on  this  question  is 
the  second  edition  of  the  remarkable  production  of  Professor  Arthur 
Biedl,  "  Innere  Sekretion,  ihre  physiologischen  Grundlagen  und  ihre 
Bedeutung  fiir  die  Pathologie."  It  contains,  perfectly  classified, 
all  that  has  appeared  of  interest  on  the  internal  secretions  up  to  the 
year  1913.^  The  physiological  researches  and  experiments  are 
herein  particularly  well  set  forth. 

As  I  have  the  honor  and  the  pleasure  of  having  Professor  Biedl 
himself  as  co-reporter,  I  would  show  poor  taste  in  not  leaving  it  to 
him  to  demonstrate  the  physiological  part  of  the  question. 

1  shall  limit  myself  then  to  the  pathological  part.  From  a 
pathological  standpoint  the  relations  of  the  internal  secretions  and 
the  nervous  system  are  far  from  being  completely  cleared  up,  as 
one  may  gather  from  the  recent  reports  of  N,  Pende,'  G.  Ghedini* 
and  Parhon^  at  the  congress  of  1912  and  191 3,  and  I  have  no  hesi- 
tancy in  stating  with  the  Philalèthe  of  the  Philosophical  Dialogues 
of  Renan:  "  For  my  part  I  am  accustomed  to  classify  my  ideas  on 
the  subject  in  three  categories.  The  first,  unfortunately  very 
limited,  is  that  of  the  certainties;  the  second  is  that  of  the  proba- 
bilities; the  third  is  that  of  dreams.  We  will  refrain  from  men- 
tioning the  last  if  you  please,  Euthyphron,  as  in  all  probability  it 
exists  for  each  one  of  us  as  the  dearest  part  of  all." 

In  fact,  since  my  report  of  1908  at  the  Congress  of  Dijon,  on 

2  I  refer  here  for  the  bibliography,  also  to  the  recent  volume  of  Pr.  Gley, 
Les  Secretions  internes,  Baillière,  1914. 

3  N.  Pende,  Les  secret,  int.  en  rapport  avec  la  clinique,  XXII  Cong,  de 
la  Soc.  italienne  de  med.  int.,  Rome,  oct.,  1912. 

♦  G.  Ghedini,  idem. 

"  Parhon,  Les  gl.  à  secret,  int.  dans  leurs  rapp.  avec  la  psychol.  et  la 
pahtol.  mentale,  rapport.  Congrès  internat,  de  Neurol,  Gaud,  1913. — Voire 
aussi:  Parhon  et  Goldstein,  Les  secret,  int.,  Maloine,  1909;  W.  Falta,  die 
Erkrankungcn  der  Blutdrusen,  Berlin,  1913;  Lucien  et  Parisot,  Gl.  surr.  el 
org.  chromaffines,  Gittler,  1913;  Lewandowsky,  Uandbuch  der  Neurologie, 
Bd.  IV,  Innere  Sekretion  und  Nervensystem,  Berlin,  1913.  See  more  com- 
plete Bibliography  in  Jclliffe  and  White,  Diseases  of  the  Nervous  System,  I, 
Endocrinology,  2d  Edit.,  1917. 


xii  THE   INTERNAL   SECRETIONS   AND 

psychic  troubles  caused  by  disorders  of  the  glands  of  internal  secre- 
tion, where  I  insisted  on  the  importance  of  these  glands  in  neurology 
and  psychiatry,  the  glands  of  internal  secretion,  heretofore  ignored, 
have  now  become  the  special  study  of  medical  men,  so  that  all  or 
nearly  all  of  them,  clinicians,  anatomico-pathologists,  experimenters 
and  therapeutists  started  investigating  and  consequently  to-day  one 
invokes  with  too  much  facility  their  disturbances  as  a  causative 
factor  each  time  one  is  puzzled.  Next  to  the  sympathetic,  the 
abnormalities  of  which  were  more  dwelt  upon  than  was  warranted, 
the  endocrine  glands  have  become  the  maids  of  all  work  of  physio- 
pathology. 

It  seems  wise  to  me  to  expostulate  against  this  excess.  It  has  a 
tendency  in  effect  to  prejudice  against  endocrinology  such  critical 
minds  which  are  more  impressed  by  the  lack  of  strict  truth  and  the 
foundation  of  vagrant  theories  than  by  the  biological  interest  of 
precise  facts,  verified  over  and  over  again. 

In  this  question  of  the  relationship  of  the  internal  secretions  and 
the  nervous  system  one  should  be  assured  above  all  of  the  reality  of 
the  facts  under  consideration,  then  these  should  be  analyzed  as  to 
their  details  in  order  to  grasp  their  divers  elements,  and  to  unravel 
their  component  parts,  finally  one  should  not  extend  their  reach 
beyond  the  conditions  that  determine  them,  extrapolation  not  being 
generalization. 

From  the  standpoint  of  pathology  as  from  the  standpoint  of 
physiology  the  relations  of  the  internal  secretions  and  the  nervous 
system  interest  us  in  so  much  as  they  are  relations  of  causality. 

My  first  aim  then  is  to  show  that  in  pathology  there  exist,  on 
the  one  hand,  nervous  disorders  due  to  disturbance  of  the  internal 
secretions,  and  on  the  other  hand,  disturbance  of  the  internal  secre- 
tions due  to  nervous  disorders. 

Before  establishing  this  double  relationship  it  is  necessary  to 
define  exactly  the  terminology.  Nervous  troubles  mean  to  me  all 
the  disturbances  of  the  nervous  system,  the  motor  symptoms,  sen- 
sory symptoms,  trophic  and  psychic  symptoms  with  their  anatomical, 
physical  and  chemical  correlations.  These  disorders  are  divided 
into  three  groups  according  as  to  whether  they  pertain  to  the  sen- 
sory-motor, vegetative  or  psychic  functions. 

The  sensory-motor  disturbances  are  above  all  the  expression  of 
the  neuraxis,  the  vegetative  of  the  vago-sympathetic,  and  the 
psychic  of  the  cerebral  cortex. 

One  knows  that  Langley  has   differentiated  in  the  vegetative 


THE   NERVOUS   SYSTEM  Xlll 

system  that  which  he  calls  the  autonomic  from  the  sympathetic 
system.  This  consists  of  the  cephalic  portion  which  proceeds  from 
the  mid-brain  and  the  bulb — the  oculomotor  nerve,  the  pneumo- 
gastric  and  the  chorda  tympani — and  of  the  sacral  portion  running 
from  the  cord — the  pelvic  nerves.  This  system,  of  which  the  ruling 
element  is  the  pneumogastric,  presents  a  functional  antagonism  to 
the  sympathetic. 

Thus,  for  example,  the  sympathetic  dilates  the  pupil,  causes  the 
eyeball  to  protrude,  accelerates  the  heart  action,  inhibits  the  move- 
ments of  the  intestine,  dilates  the  sphincter  ani,  produces  glycosuria 
and  polyuria.  Inversely  the  autonomic  system  contracts  the  pupil, 
relaxes  the  zonule  of  Zinn,  slows  the  heart  action,  contracts  the 
muscles  of  the  intestine,  increases  the  gastric  and  pancreatic 
secretions. 

Eppinger  and  Hess^  have  striven  to  demonstrate  this  in  man  by 
the  aid  of  pharmacodynamic  tests,  injections  of  adrenalin,  of  pilo- 
carpine and  of  atropine.  They  have  given  the  name  of  vagotonics 
to  individuals  in  whom  the  activities  of  the  autonomic  predominate 
and  of  sympathicotonics  to  individuals  in  whom  the  sympathetic 
excels. 

Adrenalin  dilates  the  pupil,  contracts  the  blood  vessels,  acceler- 
ates the  heart  action,  increases  arterial  tension,  produces  polyuria, 
glycosuria  and  reflex  excitability. 

Pilocarpine  incites  salivation,  sweating,  blushing,  increase  of  in- 
testinal peristalsis,  hypersecretion  of  digestive  fluids  and  intestinal 
juice. 

Atropine  dilates  the  pupil,  stops  secretion,  and  sometimes  ac- 
celerates the  heart. 

Eserine,  introduced  by  Mougeot,'  vago-excitant,  slows  the  pulse, 
raises  pressure,  and  contracts  the  intestine. 

One  speaks  of  adrenalin  as  exciting  the  sympathetic,  of  pilo- 
carpine and  eserine  as  exciting  the  autonomic,  and  of  atropine  as 
paralyzing  the  latter. 

When  a  subcutaneous  injection  of  one  milligram  of  adrenalin 
produces  a  glycosuria  in  excess  of  5  grams,  when  the  quantity  of 
urine  is  doubled  and  the  pulse  has  a  rhythm  one  third  above  normal, 
one  speaks  of  sympathicotonia. 

«  H.  Eppinger  et  L.  Hess,  Zur  Pathologie  des  vegetativen  Nervensystems, 
Deutsch.  Arch.  f.  klin.  Med.,  1909,  LXVIII,  3-4,  P-  231.  See  Monograph  No. 
20,  this  series.    Translated  by  Kraus  and  Jelliffe. 

^  Mougeot.  A.,  Lc  réflexe  oculo-cardiaque,  Soc.  de  Med.  de  Paris,  28  mars, 
1914,  pp.  277-287. 


xiv  INTERNAL   SECRETIONS   AND    NERVOUS   SYSTEM 

When  a  subcutaneous  injection  of  one  centigram  of  nitrate  of 
pilocarpine  produces  a  salivation  and  sweating  more  abundant  than 
normal  one  speaks  of  vagotonia. 

When  a  subcutaneous  injection  of  one  milligram  of  the  neutral 
sulphate  of  atropine  produces  a  rapid  and  prolonged  dilatation  of 
the  pupil  with  considerable  increase  of  the  pulse  rate  one  speaks 
again  of  vagotonia. 

When  finally  a  subcutaneous  injection  of  a  quarter  of  a  milli- 
gram of  hydrobromate  of  eserine  does  not  produce  an  appreciable 
slowing  of  the  heart  nor  contractions  of  the  intestines  one  speaks 
either  of  hypovagotonia  or  sympathicotonia. 

The  oculo-cardiac  reflex,  discovered  by  Aschner,  allows  one  also 
to  take  notice  of  the  respective  activities  of  the  sympathetic  and 
pneumogastric 

In  the  normal  state  and  in  the  recumbent  position,  pressure  on 
the  eyeballs  with  the  pulp  of  the  fingers  softly  for  30  seconds  with- 
out pain,  determines  after  the  lapse  of  a  few  seconds  a  slowing  of 
the  pulse,  lowering  of  arterial  tension,  slowing  of  the  respiration 
and  sometimes  a  feeling  of  nausea. 

The  reflex  is  positive  when  the  slowing  of  the  pulse  is  in  excess 
of  12  beats  per  minute. 

It  is  normal  when  the  slowing  is  at  least  4  and  less  than  12 
beats  per  minute. 

It  is  negative  when  there  is  no  reaction  or  one  of  less  than  4 
beats  per  minute. 

It  is  inverted  when,  without  excitement  or  pain,  the  slowing  of 
the  pulse  is  replaced  by  acceleration. 

When  the  reflex  is  positive,  one  speaks  of  vagotonia;  when  it  is 
negative  or  inverted,  of  sympathicotonia. 

Thus,  thanks  to  these  researches,  two  clinical  types  among  the 
vegetative  neurotics  are  clearly  determined. 


CHAPTER   I 

The  young  girl,  who  complains  of  palpitations  and  precordial 
pains  with  slight  tachycardia,  burning  pains  in  the  stomach,  diar- 
rheas and  sweating  attacks,  in  spite  of  being  chilly  and  having  cold 
feet;  who  has  profuse  lachrymation,  who  is  often  nauseated,  and 
who  has  tendencies  to  be  sick  especially  before  her  periods,  who  is 
easily  seasick,  who  dislikes  to  ride  backwards  in  a  carriage  or  rail- 
road car  ;  who  with  a  large  palpebral  fissure  has  a  slight  exophthal- 
mos ;  who  has  a  clear  von  Graef  e's  sign  without  the  sign  of  Mobius  ; 
who  has  an  abnormally  low  arterial  tension,  with  perhaps  an  eosino- 
philia;  whose  overcontracted  pupils  are  not  dilated  by  adrenalin, 
and  which  contract  with  expiration  (Samogyi's  sign);  who  has  an 
alimentary  glycosuria  with  adrenalin  ;  who  has  secretory  crises  with 
pilocarpine  ;  and  finally  who  is  benefited  marvellously  by  atropine  as 
regards  dyspeptic  troubles,  and  whose  constipation  disappears  at 
once — she  is  a  vagotonic. 

The  woman  with  a  well-marked  tachycardia  and  few  subjective 
symptoms;  with  exophthalmos  and  no  von  Graefe's  sign,  but  with 
a  clear  sign  of  Mobius;  with  a  large  pupil  and  scanty  lachrymal 
secretion  ;  who  has  no  sweats  or  diarrheas  ;  with  very  marked  loss  of 
hair,  with  a  tendency  towards  fever;  who  is  always  too  warm; 
whose  pupil  dilates  with  adrenalin,  who  also  has  an  alimentary 
adrenalin  glycosuria;  who  does  not  react  to  pilocarpine,  and  stands 
atropine  badly — she  is  a  sympathicotonic. 

This  differentiation,  true  in  general,  has  aroused  many  criticisms 
from  the  very  first,  especially  from  Fleischmann,^  Potzl,  Eppinger 
and  Hess  themselves,»  Falta,  Newburgh  and  Nobel,^"  Falta  and 
Kahn,  "  Petren  and  Thorling,^-  Burstein^^  ^^^  Bauer,"  etc.,  the 
justice  of  which  has  been  admitted  by  myself  and  my  interne  Mile. 
Romme  at  Eeaujon  Hospital. 

It  is  thus  that  we  have  seen  intense  reactions  to  pilocarpine  at 
the  same  time  that  adrenalin  shows  an  exaggerated  excitability  of 

8  Fleischmann,  Med.  Klinik,  4  fev.,  1910. 

»  O.  Potzl,  H.  Eppinger  et  L.  Hess,  Wien.  klin.  Woch.,  22  dec,  1910. 
10  \v.  Falta,  L.-H.  Newburgh  et  E.  Nobel,  Zeitschr.  f.  klin.  Med.,  1914, 
LXXII,  1-2. 

"  VV.  Falta  et  F.  Kahn,  Zeitschr.  f.  klin.  Med.,  1912,  LXXIV. 

"K.  Petren  et  I.  Thorilng,  Zeitschr.  f.  klin.  Med.,  1912,  LXXIII,   1-2. 

'''M.  Burstein,  Med.  Obozr.,  1912,  LXXII,  10. 

"J.  Bauer,  Deutsch.  Arch.  f.  klin.  Med.,  1912,  CVII,  i. 


2  THE   INTERNAL   SECRETIONS   AND 

the  vegetative  system,  the  same  individual  presenting  at  intervals 
of  some  days  different  reactions,  and  adrenalin  glycosuria  has  no 
value  until  the  hepatic  element  is  eliminated. 

Finally  I  wish  to  state  that  the  term  tonic  or  tone  does  not  seem 
to  me  well  chosen,  because  it  deals  more  with  an  exaggeration  of 
the  excitability  of  the  nerve  rather  than  an  increase  of  its  tonicity, 
and  these  two  states  are  far  from  being  always  parallel. 

Be  that  as  it  may,  I  differentiate  in  nervous  disorders  in  addition 
to  sensory-motor  troubles  and  psychoses,  the  disorders  of  the  vege- 
tative system,  and  these  sympathetic  and  autonomic  abnormalities. 
We  shall  see  later  on  that  these  disorders  do  not  separate  them- 
selves into  parallel  series  as  simply  as  the  theory  would  have  them 
do.  Then  again  many  trophic  disorders  observed  in  endocrine  syn- 
dromes are  not  actually  trophoneuroses.  It  seems  quite  often  that 
endocrine  commotions  reecho  on  the  morphology  through  a  humoral 
intermediary  and  not  through  a  nervous  one.  Nevertheless,  as  I 
can  not  dissociate  in  the  actual  enumeration  of  the  trophic  dis- 
orders those  that  have  a  nervous  intermediary  from  those  that  have 
none,  I  will  discuss  them  all,  later  on  indicating  how  they  may  be 
distinguished. 

Commotions  of  the  internal  secretions  should  include  the  dis- 
turbances of  all  the  internal  secretions,  that  is  to  say,  all  humoral 
pathology  not  to  say  all  the  pathology,  because  every  cell  from  a 
cytological  standpoint  is  a  gland  of  internal  secretion,  and  following 
Renault,  who  showed  the  secretory  value  of  the  cells  of  the  con- 
junctivae, Nageotte,  just  recently  by  mitochondrial  methods,  has 
demonstrated  the  secretion  of  the  neuroglia,  which  was  thought 
formerly  to  be  a  simple  tissue  of  support.^*^ 

In  order  to  be  brief,  and  admitting  the  three  distinctive  condi- 
tions, histological,  chemical  and  physiological,  of  the  glands  of  in- 
ternal secretion,  claimed  by  Gley^^  at  the  recent  Congress  of  London, 
I  will  only  picture  among  the  internal  secretions  those  that  depend 
upon  definite  glands,  in  the  front  ranks  of  which  I  will  place  the 
classical  hemato-vascular  glands:  thyroid,  parathyroids,  pituitary, 
suprarenals,  ovaries  and  testicles. 

I  will  add  to  this  group  the  pineal,  which  in  the  infant,  histo- 
logically as  well  as  physiologically,  is  an  endocrine  gland  ;  the  choroid 
plexus,  of  which  the  secretion  diffused  in  the  cerebro-spinal  fluid 
has  been  demonstrated  by  Pettit  and  Girard;  the  prostate,  whose 

1*^  See  Translation  of  Achucarro,  Jl.  Nervous  and  Mental  Disease,  Oct., 
1918,  p.  333. 

'^^  E.  Gley,  Relat.  entre  les  organes  à  sécrétion  int.  et  les  troubles  de  ces 
secret,  Rapport,  sect,  de  Physiol.,  Congrès  internat.,  Londres,  1913. 


THE    NERVOUS   SYSTEM  3 

elective  action  on  the  genital  organs  has  been  brought  in  evidence 
by  Hallion,  Papin  and  MoreP®  and  the  paraganglia  of  the  sym- 
pathetic, which  are  chromaffin  organs  apart  from  the  suprarenals. 

In  addition  among  the  glands  of  external  secretion,  certain  ones 
have  at  the  same  time  an  internal  secretion  of  such  importance  that 
I  must  at  least  mention  them;  such  are  the  liver,  the  kidney,  the 
pancreas,  the  salivary  glands,  the  mammary  glands  and  the  in- 
testinal glands  of  which  the  endocrine  action  has  been  grasped 
histologically  by  P.  Masson."  Among  these  I  will  retain  only  the 
pancreas  on  account  of  its  participation  in  the  mechanism  of 
glycosurias. 

Finally  among  the  lymphoid  glands,  ganglia,  thymus  and  spleen, 
the  thymus  at  least  plays  a  secretory  rôle. 

I  will  consider  then  the  nervous  disorders  linked  with  disturb- 
ances of  the  thyroid  and  parathyroids,  the  thymus,  the  suprarenals 
and  paraganglia  of  the  sympathetic,  the  pancreas,  the  pituitary,  the 
pineal  and  the  choroid  plexus,  the  ovary,  the  testicles  and  the 
prostate. 

In  this  clinical  analysis  I  shall  recapitulate  at  first  in  a  critical 
review  as  briefly  as  possible  the  nervous  disorders  existing  in  the 
syndromes,  that  one  as  a  rule  places  among  the  disturbances  of  the 
endocrine  glands,  that  I  have  just  mentioned,  and  reciprocally  the 
endocrine  disorders  observed  in  the  nervous  syndromes. 

In  this  critical  review  I  will  bring  out  the  elements  of  an  endo- 
crino-neurological  scheme,  in  which  by  the  choice  of  certain  nervous 
symptoms,  certain  endocrino-vegetative  syndromes,  certain  tradi- 
tional nervous  syndromes,  certain  temperaments,  certain  characters, 
I  will  attempt  to  show  by  the  method  of  double  weighing,  that  some 
among  them  are  determined  by  an  endocrine  commotion  in  certain 
cases,  and  that  in  others  they  are  the  expression  of  a  nervous  up- 
heaval of  different  origin  reacting  secondarily  on  the  internal 
secretions. 

And  I  will  gather  from  this  rather  suggestive  study  of  a  subject 
so  complex  and  so  obscure  some  conclusions  which  I  will  advance 
for  your  discussion. 

^^  Hallion,  Morel  et  Papin,  Act.  vaso-dilatatrice  péniesme  de  I'extr. 
prostateq.,  Soc.  de  biol.,  28  fev.,  1913,  p.  401. 

"  Masson,  P.,  La  gl.  endocrine  de  l'intestin  chez  l'homme,  Acad,  des  Se, 
5  janv.,  1914. 


4  THE   INTERNAL   SECRETIONS   AND 

A.   Critical  Review 

The  endocrino-neurological  clinical  relationships  form,  a  priori, 
two  big  groups  : 

1.  Nervous  disorders  in  the  endocrine  syndromes. 

2.  Endocrine  disorders  in  the  nervous  syndromes. 

Before  discussing  these  I  must  explain  the  value  of  the  methods 
of  investigation  which  are  permissible  for  proof.  I  will  be  very  brief 
as  regards  the  neurological  methods  and  a  little  more  explicit  as 
regards  the  endocrinological  procedures. 

(a)  Methods  of  Neurological  Investigation 

I  skim  over  the  current  clinical  methods  employed  for  unravel- 
ling the  motor,  sensory,  lisso-motor,  secretory,  trophic  and  psychic 
disorders  of  the  nervous  system  to  pause  at  the  more  complex  ex- 
perimental tests  in  clinical  use  to  establish  the  so-called  states  of 
vago-  and  sympathicotonia.  These  tests  are  at  the  starting  point 
chemical  or  mechanical.  The  first  are  the  injections  of  adrenalin, 
of  atropine,  of  pilocarpine,  of  eserine;  the  second  are  the  ocular, 
auricular  or  solar  ganglion  tests  permitting  the  consideration  of  the 
oculo-cardiac,^^  auriculo-cardiac  and  cœliac  hypotensory  reflexes.^" 

Now  each  of  these  tests  determines  a  series  of  reactions  already 
quoted. 

In  order  to  judge  of  their  diagnostic  bearing  on  the  neurological 
status  one  makes  three  hypotheses. 

The  first,  that  the  antagonism  between  the  sympathetic  and  the 
autonomic  is  complete. 

The  second,  that  just  one  of  the  results  of  each  of  the  tests, 
which  one  regards  as  characteristic,  is  representative  of  the  general 
orientation  of  all  the  results  of  that  test. 

The  third,  that  the  orientation  of  the  test  so  determined  is  of 
use  for  deciding  not  only  the  state  of  the  function  thus  investigated, 
but  the  state  of  the  whole  sympathetic  or  autonomic  nervous 
system. 

Now  as  regards  the  first  hypothesis  one  can  reply  that  if  phar- 
macodynamics bring  the  innervation  of  the  sweat  glands  under  the 
control  of  the  autonomic,  there  is  nothing  in  anatomy  or  physiology 
to  permit  it  to  be  separated  from  the  sympathetic. 

To  the  second  one  can  answer  that  the  results  so  often  dis- 

18  For  the  recent  French  bibliography,  see  :  Vernet  et  Petzetakis,  Le  réflexe 
oculo-cardiaque,  Gaz.  des  hop.,  2  mai,  1914. 

19  André,  Thomas,  et  J.,  Ch.  Roux.  Soc.  de  biol.,  23  mai,  1914,  p.  857. 


THE    NERVOUS   SYSTEM 


sociated  of  adrenalin  or  atropine,  raised  blood  pressure  without 
glycosuria  or  vice  versa,  dilatation  of  the  pupil  without  acceleration 
of  the  heart  or  vice  versa,  show  clearly  that  one  can  not  draw  con- 
clusions from  the  character  of  the  physiological  reaction,  consider- 
ing from  the  same  standpoint  the  character  of  all  the  other  possible 
reactions  that  one  has  neglected. 

In  a  stronger  way  one  should  respond  to  the  third  hypothesis 
that  the  frequent  confirmation  of  reactions  in  an  inverse  sense, 
of  the  vagotonic  and  sympathicotonic  classification  shows  that  one 
can  not  judge  of  such  states  from  one  single  reaction,  but  further 
that  the  frequent  confirmation  of  reactions  in  an  inverse  sense, 
sympathicotonic  or  vagotonic,  that  I  have  often  observed  as  a  re- 
sult of  diflferent  tests  and  even  of  the  same  test,  shows  at  least  the 
association  or  the  succession  of  these  two  states  of  the  vegetative 
system,  and  in  consequence  diminishes,  if  not  the  importance  of  the 
doctrine,  at  least  the  practical  interest  of  this  classification,  of 
which  the  clear-cut  outlines  and  the  antagonism  seem  to  have  been 
exaggerated. 

(b)  Methods  of  Endocrinological  Investigation 

These  methods  are  clinical,  anatomical,  organotherapeutic,  phys- 
iological and  chemical.  In  my  report  of  1908  I  have  shown  the 
inherent  causes  of  error  in  the  first  three. 

Clinically  one  must  not  in  an  endocrino-neurological  complex, 
of  which  the  groupings  may  be  more  or  less  defaced,  pick  out  as  an 
element  of  causality  that  which  perhaps  is  nothing  more  than  a 
co-result  of  the  same  cause  or  which  has  nothing  but  a  contingent 
relationship  with  the  nervous  or  endocrine  disorder. 

In  anatomo-morphological  pathology  one  gathers  facts  of  in- 
contestable value,  and  that  is  why  I  have  continued^»  to  examine 
systematically  the  endocrine  glands  of  my  nervous  and  mental 
cases,  but  as  I  said  in  1908  one  must  always  know  how  to  read, 
and  how  to  interpret  these  data;  to  read  them,  that  is  to  say,  ob- 

20  Laignel-Lavastine,  Hyperplasias  glandulaires  de  l'hypophyse.  Congrès 
de  Neurol.,  Amiens,  191 1.  ^    '     c        j 

Laignel-Lavastine  et  Duehm,  Les  parathyroïdes  chez  les  aliènes,  Soc.  de 
biol.,  20  janv.,  1912;  30  mars,  1912;  Annales  de  Méd.  (sous  presse);  Les 
parathyroïdes  chez  les  déments  seniles,  Soc.  de  psychiatrie,  avril,  1912;  M. 
Labbé,  Laignel-Lavastine  et  Vitry,  Diabète  et  lésions  du  pancréas,  Soc. 
anatomique,  8  mars,  1912. 

Laignel-Lavastine  et  V.  Jonnesco,  L'hypophyse  des  psychopathes,  Soc. 
anatomique,  30  nov.,  1912;  Encéphale,  janv.,  1913,  pp.  25-45-  Trois  planches 
couleurs.  1.  a     j 

Laignel-Lavastine,  Anat.  pathol.  de  la  pinéale,  Mem.  couronné  par  1  Acad. 
de  Méd.,  1913,    Arch,  de  Méd.  exp.  (sous  presse). 


6  THE   INTERNAL   SECRETIONS   AND 

serve  the  physiological,  ethnic  or  geographical^^  variations,  the 
errors  of  technique,  the  post-mortem  lesions,  in  order  to  dis- 
tinguish the  normal  from  the  pathological;  to  interpret,  that  is  to 
say,  to  distinguish  in  the  pathological  lesions  those  which  are  con- 
tingent, and  are  recent  alterations  due  to  terminal  accidents,  or 
which  are  but  a  co-effect  resulting  from  the  same  cause  as  the 
nervous  disorders,  or  results  of  a  previous  infection  or  intoxication, 
in  order  to  be  able  with  these  lesions  to  establish  beyond  criticism  a 
causal  relationship  between  endocrine  disorders  and  nervous  symp- 
toms. 

Besides  a  last  difficulty  which  is  considerable  renders  these  re- 
searches sufficiently  rare  under  ideal  conditions.  The  glandular 
disorders,  which  for  the  sake  of  argument  one  supposes  to  have 
reacted  on  the  mental  condition,  are  seldom  severe  enough  to  re- 
sult in  death. 

A  long  time  elapses  between  the  onset  of  the  trouble  and  the 
autopsy.  Thus  on  the  one  hand  additional  lesions  due  to  the  path- 
ological overcharge  can  render  old  glandular  lesions  unrecognizable, 
and  on  the  other  hand  nervous  and  psychic  symptoms  born  of  a 
glandular  disorder,  which  is  often  transitory,  may  outlast  this  dis- 
order indefinitely. 

These  examples  of  nervous  and  above  all  mental  sequelœ  of  a 
functional  upset,  which  has  ceased  for  a  long  time,  are  relatively 
very  frequent  illustrations  of  the  great  law  of  habit. 

In  organotherapy^^  when  it  is  a  question  of  establishing  a  re- 
lationship of  causality  between  a  nervous  disturbance  and  an  en- 
docrine disorder,  because  the  administration  of  the  extract  of  an 
incriminated  gland  has  been  followed  by  the  disappearance  or  at 
least  the  attenuation  of  the  nervous  syndrome  under  consideration, 
it  behooves  one  to  be  even  more  careful  than  in  any  other  thera- 
peutic induction,  being  aware  already  of  the  many  fallacies  of  such 
because  here  the  causes  of  error  are  particularly  numerous:  coin- 
cidence; general  action  on  the  organism  and  its  metabolism  by 
simple  pharmaco-dynamic  effect;  suggestion;  variability  of  the  or- 
ganotherapeutic  extracts  according  to  the  method  of  acquisition, 
of  preparation,  of  conservation,  their  age,  the  mutation  of  effect 
according  to  dosage,  the  avenue  of  introduction,  the  frequency  of 
dosage,  the  difference  between  their  action  and  that  of  the  normal 

2111  en  est  ausi  pour  la  thyroïde.  V.  Parhon,  Mile.  Mateesco,  Tupa, 
Nouv.  recherches  sur  la  thyr.  des  aliénés,  Encéph.,  aôut-sept.,  1913,  pp.  139 
et  235-55. 

22  Hallion,  L.,  La  pratique  de  l'apothérapie,  191 1. 


THE   NERVOUS   SYSTEM  7 

gland,  the  uncertainty  indeed  of  the  nervous  syndrome  being  in 
Hne  with  the  endocrine  disorder,  which  in  other  respects  may  not 
have  induced  the  nervous  syndrome  except  through  the  agency  of 
giandular  commotions  in  one  or  many  other  of  the  endocrines,  ob- 
serving as  well  other  intermediaries  such  as  mechanical,  physical, 
chemical,  humoral,  nervous  or  psychic  causes. 

In  his  report  of  19 13,  Gley  reiterated  the  causes  of  error  in 
insisting  upon  the  general  toxicity  of  organic  extracts  and  their 
variations,  depending  upon  the  method  of  preparation,  autolysis,  the 
production,  the  manner  in  which  they  are  used,  the  heating  and  the 
quickness  of  injection.  In  addition  he  has  drawn  attention  to  a 
new  cause  of  error  :  tachyphylaxis,^'  rapid  immunization  character- 
ized by  the  fact  that  successive  injections  of  organic  extracts  in 
small  doses  gives  rise  to  an  immunization  that  is  produced  in  a 
few  minutes.  This  phenomenon  of  tachyphylaxis  for  one  organic 
extract  can  be  aroused  by  the  extract  of  another  organ  and  vice 
versa.  This  crossed  tachyphylaxis  of  Gley  and  Champy  should  be 
taken  into  consideration  in  the  interpretation  of  such  complex  re- 
sults as  the  effects  of  treatments  by  simultaneous  or  successive  as- 
sociations of  glandular  extracts.  From  this  standpoint  the  theory 
of  treatment  by  hormones^*  is  guarded  from  such  causes  of  error 
because  the  hormones  entail  neither  anaphylaxis  nor  tolerance.  In 
the  above  we  have  an  instance  of  one  of  the  differences  between 
the  action  of  adrenalin  and  that  of  extracts  of  the  suprarenal  gland. 

Finally  the  new  physiological  methods,  methods  of  Abderhalden, 
methods  followed  by  Gley  and  Claude,  etc.,  are  themselves  no  longer 
shielded  from  causes  of  error. 

The  Abderhalden  method  has  already  been  applied  by  numerous 
autliors,  Urechia,^^  Pesker,-®  Parhon,^^  Obregia  and  Pilulesco," 
Marinesco  and  Papazolu,^^  Mutermilch,'°  etc.,  to  induce  from  their 
results  an  endocrinological  origin  for  numerous  nervous  and  mental 
syndromes. 

Only  recently,  following  his  researches  on  the  relations  of  the 

2s  Gley  et  Champy,  Soc.  de  biologie,  1911,  22  juillet,  p.  159;  Gley,  Livere 
jubilaire  du  Pr.  Richet,  1912,  pp.  11 1-29. 

2*  Hallion,  L.,  Sur  la  part  attribuable  aux  hormones  dans  les  effets  de 
l'opothérapie,  Soc.  de  thérapeutique,  26  nov.,  1913,  pp.  472-77. 

23  Urechia  et  Popeia,  Soc.  de  biol.,  Bucarest,  20  dec,  1913,  p.  591. 

2«  Pesker,  Ass.  scientif.  des  med.  de  l'Ass.  psychiatrique  Saint  Nicholas  a 
Saint  Petersbourg.  10  janv.,  1914. 

"  Parhon,  et  Parhon,  M.,  Soc.  de  biol.,  25  avril,  1914. 

28  Obregia  et  Pitulesco,  Soc.  de  biol.,  Bucarest,  31  janv.,  1914,  p.  316. 

*"  Marinesco  et  Papazolu,  Soc.  de  biol.,  Bucarest,  29  mai,  1914,  p.  1419. 

20  Mutermilch,  S.,  L'applicat.  de  la  react.  d'Abderhalden  au  diagnostic  et 
à  l'état  des  mal.  nerv.  et  mentales.  Arch,  de  Neurol.,  avril,  1914,  pp.  205-219. 
Bibliographie. 


8  THE  INTERNAL  SECRETIONS  AND 

internal  secretions  and  the  psychoses,  Parhon,  with  Odobesco," 
started  to  trace  a  psycho-endocrine  syndrome  characterized  from 
the  psychic  viewpoint  by  great  irascibility  and  ideas  of  persecution 
poorly  systematized,  and  from  a  somatic  viewpoint  by  ovarian  dis- 
turbances, irregular  menstruation  or  amenorrhea  and  especially 
thyroidal  disturbances,  congestion  of  the  face,  hot  flashes,  mono- 
nucleosis and  a  positive  Abderhalden  reaction  for  the  thyroid. 

Now  Plant  has  shown  that  in  Abderhalden's  reaction,  kaolin 
talc,  sulphate  of  barium  produce  dialyzable  sustances  which  react 
with  ninhydrin  just  as  the  protein  does  which  has  served  in  the 
preparation  of  the  animal,^^  and  H.  de  Waele  concluded  after  a 
series  of  experiments  that  this  ferment  is  unique  :  it  is  antithrombin. 
It  is  not  the  fragments  of  organs  or  proteins  that  undergo  pro- 
teolysis but  really  the  globulins  of  the  serum.  The  specificity  will 
simply  arise  from  the  preparatory  injection  which  has  created  con- 
ditions favorable  to  the  action  of  the  protein  on  the  globulins  of 
the  serum,  and  it  appears  probable  that  this  bears  a  close  relationship 
to  the  phenomena  of  agglutination  and  precipitation. 

Even  more  recently  Flatow^^  happened  to  show  that  it  con- 
sists of  simple  variations  of  the  proteolytic  ferments  of  the  serum. 
This  study  of  antiferments  for  the  diagnosis  of  endocrino-nervous 
relationships  is,  therefore,  to  my  mind,  extremely  dangerous.  In 
eflfect  the  recent  criticisms  of  the  Abderhalden  reaction,  in  spite  of 
the  recognition  of  the  gross  chemical  interest,  put  one  justly  on 
guard  against  its  pretended  specificity  towards  the  extracts  of  or- 
gans employed. 

I  will  then  consider  that  the  new  investigations  are  not  entirely 
conclusive  relative  to  the  existence  of  an  endocrine  factor,  based 
solely  on  the  Abderhalden  reaction. 

The  physiological  method  advocated  by  Gley  in  his  report  for 
judging  of  the  functional  capacity  of  the  affected  organ  consists 
of  injecting  into  animals  the  altered  tissue  in  order  to  see  if  it 
still  manifests  the  physiological  properties  of  normal  tissue. 

A  priori,  this  method  seems  of  value,  and,  as  Gley  says,  "this 
type  of  study  seems  to  recommend  itself  in  a  general  way  to 
pathologists.  The  anatomo-pathological  research  which  allows  cer- 
tain lesions  to  be  authenticated  should  be  amplified."    And  as  an 

31  C.  J.  Parhon  et  Gr.  Odabesco,  Encéphale,  lo  juin,  1914,  pp.  489-582. 

32  H.  de  Waele,  Soc.  de  biol.,  25  avril,  1914,  p.  627,  et  Zeitschr.  f. 
Immunitatsf. 

33  Flatow,  A  propos  de  la  spécificité  des  soi-desant  ferments  protecteurs, 
XXXI  Cong.,  allemand  de  med.  int.,  Wiesbaden,  mai,  1914. 


THE   NERVOUS   SYSTEM  9 

example  he  has  cited  his  experiences  with  the  cardiovascular  action 
of  adrenal  extract  from  thyroidectomized  dogs  compared  with  that 
obtained  from  normal  canine  glands.  He  did  not  note  any  differ- 
ence. Porak,  who  has  followed  this  route,  has  arrived  at  unex- 
pected results.  Suprarenal  extracts  obtained  under  conditions  of 
activity  clearly  greater  than  normal  have  given  cardio-vascular  re- 
actions of  less  intensity  than  those  that  were  obtained  under  normal 
conditions.  As  the  cardio-vascular  effect  is  proportionate  to  the 
richness  in  adrenalin  one  must  conclude  that  not  only  is  the  richness 
in  adrenalin  of  the  suprarenals  not  in  proportion  to  their  activity, 
but  that  taken  at  a  given  moment  they  are  less  charged  with  adrenalin 
than  are  less  active  suprarenal  glands. 

Thus  because  function  wears  itself  out  with  persistence,  and  by 
fault  of  having  overlooked  the  time  factor,  one  has  been  exposed 
to  erroneous  deductions,  in  conclusions  drawn  from  the  physiolog- 
ical method,  which  a  priori  is  valuable  in  itself. 

It  is  good  because,  contrary  to  precedent,  it  is  capable  of  fur- 
nishing answers  during  the  life  of  the  individual.  Better  yet  be- 
cause it  seems  to  be  the  method  followed  by  Claude  and  his  pupils. 

It  consists  of  injecting  divers  glandular  extracts  into  patients, 
and  observing  their  reactions  systematically,  and  deducing  from 
these  reactions  the  probable  endocrine  disorders.  Thus  it  permits 
the  acquisition  of  individual  indicators  of  physiological  endocrine 
reactions,  which,  counting  on  the  complexity  of  the  cases,  by  the 
comparison  of  a  large  number  of  facts,  may  allow  the  formation 
of  hypotheses  if  not  of  conclusions.  Claude  with  his  pupils, 
Baudouin  and  Porak,  has  already  used  this  method  with  success 
in  the  study  of  acromegalics,  Addisonians  and  just  recently  of 
Basedowians." 

The  many  criticisms  summed  up  by  Biedl  and  Falta  and  Porak" 
have  done  full  justice  to  the  serological  methods,  such  as  that  of 
Meltzer-Ehrmann,  based  upon  the  supposed  fact  that  dilatation  of 
the  enucleated  eye  of  the  frog,  in  the  presence  of  any  serum  in- 
dicates the  existence  of  adrenalin  in  that  serum.  Mydriasis  can 
be  brought  about  by  other  causes  than  the  presence  of  adrenalin. 
It  is  useless  to  argue  further. 

There  remains  the  need  of  knowing  how  to  interpret  the  results 
of  the  clinical,  organotherapeutic,  anatomo-pathological  and  phys- 
iological methods  (Claude  type). 

'*  Claude,  H.  Baudouin,  R.  Porak,  L'épreuve  des  extr.  hypophysaires  chez 
les  bascdowiens,  Soc.  méd.  des  hop.,  19  juin,  1914,  11 12. 

3'^  Porak,  L'épreuve  de  l'hypophyse  dans  les  maladies  des  glandes  à 
sécrétion  interne.,  Thèse,  1914. 


10  THE   INTERNAL   SECRETIONS   AND 

I  will  now  sum  up  the  nervous  disturbances  in  the  endocrine  syn- 
dromes and  the  endocrine  disturbances  in  the  nervous  syndromes  as 
rapidly  as  possible,  because  one  finds  them  to-day  explained  at  length 
everywhere. 

I.  Nervous  Disturbances  in  the  Endocrine  S5mdromes 

Endocrine  syndromes  are  increasing  every  day,  perhaps  because 
one  finds  definite  endocrinal  lesions  in  a  syndrome  till  now  con- 
founded with  an  analogue,  perhaps  because  one  now  erects  at 
pleasure  endocrine  theories  for  divers  affections  of  unknown 
origin.  The  first  way  is  legitimate,  although  of  a  rather  delicate 
interpretation — in  fact  we  are  all  familiar  with  the  frequency  of 
lesions  in  the  endocrine  glands  in  all  sorts  of  autopsies.  The 
second  is  singularly  fallacious  when  it  depends  only  on  experi- 
mental or  clinical  analogies  or  on  debatable  anatomical,  humoral 
or  therapeutic  authentications.  The  syndrome  of  dystrophia 
adiposo-genitalis  due  to  a  pituitary  lesion  and  precocious  macro- 
genito-somatosis  due  to  a  pineal  lesion  are  examples  of  the  first. 
The  endocrine  theories  as  to  the  origin  of  seasickness,  hysteria, 
Paget's  disease,  cholera  are,  in  their  turn,  examples  of  the  second. 

In  the  beginning,  in  the  period  which  might  be  called  the  uni- 
endocrine,  each  syndrome  was  connected  with  a  lesion  of  one  single 
gland,  Basedow's  with  the  thyroid,  Addison's  with  the  suprarenals, 
acromegaly  with  the  pituitary,  and  in  each  gland  only  disorders  of 
increase  or  decrease  of  secretion  were  seen  (quantitative  period). 

In  the  meantime,  after  many  others,  I  had  shown  with  Thaon  in 
1905  a  case  of  Basedow's  disease  in  a  woman  with  myxedema, 
which  the  simple  quantitative  theory  could  not  explain. 

Meanwhile,  in  1904,  in  reference  to  a  case  of  acromegaly  with 
hypertrophy  of  the  pituitary,  the  thyroid  and  the  suprarenals,  I 
and  M.  Ballet^^  attempted  to  explain  these  glandular  reactions  by 
claiming  functional  correlations  among  the  endocrines,  and  I  ad- 
vanced the  hypothesis  of  a  humoral  process. 

Shortly  after,  Claude^'^  insisted  upon  the  existence  of  several 
endocrine  reactions  in  acromegalics. 

After  this  quantitative,  uniendocrine  organic  period  there  fol- 
lowed the  polyendocrine  period,  which  is  rendered  memorable  by 
the  ringing  memoir  of  Claude  and  Gougerot^^  on  the  pluriglandular 

3«  G.  Ballet  et  Laignel-Lavastine,  Soc.  de  Neurol.,  juillet,  1904,  R.  N., 
p.  793- 

2''  Claude,  Soc.  de  biol.,  28  oct.,  1905,  p.  362. 

38  Claude  et  Gougerot,  Soc.  de  biol.,  dec,  1907,  p.  785.  Journ.  de  physiol. 
et  path,  gén.,  juin,  1908. 


THE   NERVOUS   SYSTEM  1 1 

syndromes  pertaining  to  a  tuberculous  case  with  a  testicular-adreno- 
thyroidal  insufficiency. 

Subsequently  on  June  24  at  my  course  at  Laennec  on  the  medical 
anatomy  and  physiology  of  the  secretions  I  delivered  a  lecture, 
published  afterwards,»»  on  the  correlation  of  the  glands  of  internal 
secretion  and  their  pluriglandular  syndromes,  and  M.  Renon" 
established  a  clinic  at  Necker. 

Following  this  one  spoke  of  nothing  but  pluriglandular  syn- 
dromes, because  really  the  disorders  are  hardly  ever,  if  ever,  limited 
to  one  gland  exclusively.  But  after  having  been  too  limited,  we 
exaggerated  in  the  opposite  sense.  It  is  not  logical,  because  the 
endocrinal  disorders  in  the  pathological  state  have  many  glandular 
echoes,  as  in  the  normal  state  the  functional  correlations  run  along 
in  humoral  harmony,  to  speak  of  pluriglandular  syndromes  when 
but  two  glands  are  involved. 

In  addition  if  classical  endocrine  syndromes  such  as  Basedow's 
syndrome,  Addison's  syndrome  and  diabetes  insipidus  are  often 
allied  to  a  microscopical  lesion  of  the  thyroid,  the  suprarenals  or 
the  pancreas,  sometimes  these  lesions  lack  emphasis,  and  one  is 
forced  to  admit  a  nervous  disorder  reacting  on  these  glands.  It  is 
this  that  I  endeavored  to  demonstrate  in  my  theses  on  the  solar 
plexus,"  where  side  by  side  in  Addisonian  syndromes  with  micro- 
scopic lesions  of  the  suprarenals  I  published  others  without  such 
lesions.  As  I  have  stated,  a  syndrome  being  the  clinical  expression 
of  a  disturbance  of  function,  it  is  brought  about  either  by  a  glandular 
lesion  which  controls  that  function  or  by  a  lesion  of  the  nervous 
system,  which  regulates  that  gland.  To  the  lesional  contingency  is 
opposed  the  functional  necessity.  All  the  cases  which  are  not  ex- 
plained by  the  organic  theory  place  themselves  easily,  on  the  con- 
trary, in  the  physiological  theory,  which  is  much  more  compre- 
hensive. Hence  one  must  know  how  to  substitute  the  single  phys- 
iological or  the  qualitative  or  quantitative  polyendocrine  explana- 
tion for  the  quantitative  organic  uniendocrine  interpretation  which 
is  the  oldest  and  simplest. 

To  sum  up,  endocrine  syndromes  may  depend  not  only  on  a 
lesion  of  a  corresponding  gland  or  of  its  regulating  nervous  mech- 
anism, but  indeed  upon  an  upset  of  one  or  the  other  of  an  infectious 
or  toxic  origin;  the  glandular  trouble  may  be  not  only  quantitative 
but  qualitative;  it  may  depend  not  only  on  one  gland  but  upon 

•■"o  Laignel-Lavastine,  Gaz.  des  Hop.,  14  nov.,  1908,  pp.  1563-71. 
<°Renon,  Journ.  des  practiciens,  25  juill.,  1908. 
*^  Laignel-Lavastine,  These  de  Paris,  1903. 


12  THE  INTERNAL  SECRETIONS  AND 

many,  and  in  the  latter  case  with  predominance  on  one  or  on  several 
of  them,  sometimes  without  appreciable  clinical  ascendancy,  I  will 
therefore  enumerate  the  uniendocrine  syndromes  and  the  polyen- 
docrine  syndromes,  and  I  will  divide  the  latter  into  two  groups 
according  as  to  whether  a  preponderance  in  the  disorders  of  cer- 
tain glands  can  be  differentiated  or  not. 

From  this  enumeration  of  the  endocrine  syndromes  it  will  be- 
come evident  that  endocrinogenous  nervous  disorders  exist.  The 
interpretation  of  facts  is  more  delicate  from  the  viewpoint  of  the 
Viennese  School,  which,  in  a  parallel  manner  to  the  division  of  the 
vegetative  system  into  sympathetic  and  autonomic  systems,  and 
after  having  admitted  the  relationship  of  excitation  and  inhibition 
of  the  divers  glands,  one  on  the  other  (the  triangular  schema  of 
Eppinger,  Falta  and  Rudinger  reproduced  everywhere),  divides 
these  same  endocrine  glands  into  two  groups,  of  which  one  formed 
especially  of  the  suprarenals,  the  thyroid  and  the  pituitary  excites 
the  sympathetic,  while  the  other  formed  especially  of  the  pancreas 
and  parathyroids  excites  the  autonomic. 

'A.  Uniendocrine  Syndromes 

The  ensuing  is  the  enumeration  of  nervous  disorders  noted 
in  the  divers  syndromes  as  depending  on  the  following  endocrine 
glands:  thyroid,  parathyroids,  thymus,  suprarenals,  paraganglia  of 
the  sympathetic,  pancreas,  pituitary,  pineal,  choroid  plexus,  ovary, 
testicle  and  prostate. 

I.  Thyroid 

1.  Myxedema:  Arrest  of  development,  dwarfism,  infantilism,  in- 
filtration of  the  skin,  mental  torpor,  dull  ideation,  defective  memory, 
apathy,  laziness,  sluggishness,  somnolence,  taciturnity,  awkwardness, 
slow,  monotonous,  raucuos,  nasal  voice;  small  pulse,  rapid  and 
irregular,  sometimes  with  hypertension;  constipation,  scanty  urine, 
subnormal  temperature,  chilliness,  headaches,  slight  knee  jerks;  no 
alimentary  glycosuria  ;  sometimes  epilepsy. 

2.  Basedow's  syndrome:  Tachycardia,  arrhythmia,  anxiety,  pulsa- 
tion of  the  arteries  of  the  neck:  exophthalmos,  lachrymation.  Von 
Graefe's  sign  (lack  of  synergy  in  the  movements  of  the  upper  eye- 
lid and  the  globe),  Stellwag's  sign  (lengthening  of  the  palpebral 
fissure  and  incomplete  closure  of  the  eyes),  Mobius's  sign  (diffi- 
culty in  convergence)  ;  facial  paresis,  a  giving  way  of  the  legs, 
epilepsy,  transient  attacks  of  tetany,  cramps,  tremblings,  ocular 
frontal  headaches;  colics,  hot  flushes,  profuse  sweats,  intolerance  of 


THE  NERVOUS  SYSTEM  13 

heat,  vasodilatation  of  the  skin,  meningitic  skin  reaction,  dermo- 
graphia,*-  transient  attacks  of  edema,  pigmentations,  urticaria, 
alopecia,  diminution  of  electrical  resistance,  polyuria,  albuminuria, 
glycosuria,  anorexia,  insatiable  hunger,  vomiting,  ptyalism,  hyper- 
chlorhydria,  diarrhea,  rapid  respiration,  Bryson's  sign  (lack  of  deep 
inspiratory  power),  suffocation,  amenorrhea,  atrophy  of  the  breasts, 
emaciation,  agitation,  emotional  instability,  volubility,  insomnia, 
emotional  stress,  susceptibility,  inquietude,  anxiety,  rage  and  some- 
times anxiety  neurosis,  obsessions,  anxious  melancholy,  cyclic  in- 
sanity, restless  excitement,  depression,  mania,  melancholia,  mental 
confusion,  epilepsy. 

Sainton*^  found  among  Basedowians  sometimes  signs  of  sym- 
pathicotonia: exophthalmos,  adrenalin  mydriasis,  lack  of  lachrymal 
secretion,  violent  tachycardia,  glycosuria,  adrenalin  reaction,  an 
absent  or  inverted  oculo-cardiac  reflex;  at  other  times  signs  of 
vagotonia:  slight  exophthalmos  with  enlargement  of  the  palpebral 
fissure.  Von  Graefe's  sign,  increased  lachrymation,  abundant  sweats, 
diarrhea,  slight  tachycardia,  no  alimentary  glycosuria,  positive  oc- 
ulo-cardiac reflex  and  a  pilocarpine  reaction  ;  and  at  still  other  times 
a  mixture  of  the  two  series. 

He  therefore  admits  of  three  forms  :  sympathicotonic,  vago- 
tonic and  mixed.^^ 

This  seems  to  me  to  be  the  rule.  Especially  as  I  have  had  oc- 
casion to  see  a  case  where  the  oculo-cardiac  reflex  was  at  various 
periods  sometimes  positive,  sometimes  normal,  negative  and  even 
inverted. 

3.  Thyroidal  insufficiencies  other  than  myxedema:  Infantilism, 
obesity,  Dercum's  syndrome,  pseudo-lipomatosis,  alopecia,  prema- 
ture grayness,  scleroderma,  urticaria,  pruritus,  relapsing  herpes, 
transitory  edemas,  migraine,  asthma,  constipation,  muco-membra- 
nous  entero-colitis,  blueness  of  the  extremities,  Raynaud's  syndrome, 
localized  erythema,  nasal  asthma,  carbohydrate  tolerance,  genital 
irritability,  hypertrophy  of  the  mammae,  chilliness. 

4.  Thyroidal  instability  of  Leopold  Levi  and  Henri  de  Roth- 
schild: (a)  With  dyshypothyroidea  predominating:  chilliness,  fall- 
ing of  the  hair,  headaches,  despairs,  weeping  fits,  giddiness,  tran- 
sient edemas,  pains,  spells  of  suffocation,  shivering  fits,  hot  flushes 
at    the    periods;     {b)     With     dyshyperthyroidea    predominating: 

*2  Alquier,  Rev.  Neurol,  30  mars  et  30  juin,  1914,  pp.  393-401  et  795. 
*2  Sainton,  P.,  Journ.  méd.  français,  15  mars,  1914. 

**  B.  Guillaumont,  Le  réflexe  oculo-cardiaque  dans  le  syndrome  de  Base- 
dow, Th.,  1914,  p.  74. 


14  THE   INTERNAL   SECRETIONS  AND 

emaciation,  heavy  eyebrows,  flashes  of  heat,  feverishness,  palpita- 
tion of  the  heart,  intestinal  spasms,  irritability,  emotivity,  phobias, 
inquietude,  overwhelming  migraines,  asthma,  hyperidrosis,  dysi- 
drosis,  tremblings;  (c)  Without  preponderance:  chilliness,  chills, 
migraines,  repeated  trips  to  the  toilet,  migratory  pains,  "  diffuses," 
"  hemmage,"  redness  of  the  eyebrows,  catamenial  neuralgias,  anxie- 
ties, large  palpebral  fissure,  swelling  of  the  feet,  variability  in  the 
size  of  the  extremities,  tremors,  nervous  crises,  hysteria. 

2.  Parathyroids 

1.  Tetany. -^^  Tingling  and  stifïness  of  the  fingers,  tonic  intermit- 
tent spasms  of  the  flexors  of  the  extremities;  flushings,  temporary 
edemas  of  the  joints,  normal  or  increased  tendinous  reflexes,  dysp- 
nea, tachycardia,  fever,  salivation,  vomitings,  diarrhea.  Trousseau 
sign  (hand  of  the  accoucheur  on  compression  of  the  arm), 
Chvostek's  sign  (brisk  and  fleeting  contraction  of  the  skin  muscles 
of  the  face  on  light  percussion  of  the  facial  nerve,  over  the  auric- 
ulo-labial  course)  and  Weiss's  sign  (brisk  contraction  of  the 
muscles  of  the  forehead,  eyebrows  and  eyelids  on  light  percussion 
of  the  temporal  branch  of  the  facial  at  the  level  of  the  external 
angle  of  the  eye)  ;  hyperexcitability  of  the  nerves  to  the  galvanic 
current,  particularly  to  the  closure  of  the  negative  current  and  the 
opening  of  the  positive  current. 

2.  Parkinson's*^  syndrome?:  Trembling,  muscular  rigidity,  pro- 
pulsion, rheumatoid  pains,  sensations  of  heat,  increased  tendinous 
reflexes,  vaso-dilatation,  sweats,  edemas,  cerebral  retardation, 
psychic  depression,  vertigoes. 

3.  Thymus 

1.  Vagotonic  symptoms'^''  of  Basedow's  syndrome  (  ?)  :  Profuse 
sweats,  palpitations,  lymphocytosis,  eosinophilia,  sensation  of 
weakness. 

2.  Myasthenia*^   of  Erb-Goldflam    (  ?)  :  Headaches,   ptosis,   ex- 

■*^  Tétanie,  résultante  d'une  insuffisance  parathyroidienne  latente,  con- 
génitale or  acquise,  qui  s'aggrave  brusquement  et  devient  manifeste  à  l'occa- 
sion d'une  traumatisme,  d'une  infection  or  d'une  intoxication  surajoutée. 
Thèse  de  R.  Lifschitz,  1914,  inspirée  par  Babonneix. 

*^  Le  syndrome  de  Parkinson  serait  hypoparathyroidien  et  s'opposerait  a 
la  myasthénie,  syndrome  hyperthyroïdien ?  (Lundborg).  Deutsche  Zeitsch. 
f.  Nervenheilk.,  Bd.  XXVII,  1904,  p.  217;  voir  de  plus:  Gautier,  J.,  Th., 
Lyon,  1913. 

*J  Rose,  Le  thymus  et  la  mal.  de  Basedow,  Sem.  med.,  21  janv.,  1914, 
d'après  Capelle  et  Bayer,  Biedl,  Klose,  Lampe  et  Liesegang. 

*8  La  coincidence  très  fréquente  d'une  gros  thymus  chez  les  myasthéniques 
est  certaine,  Claude  (Acad.  de  méd.,  juin,  1914)  admet  a  l'origine  de  certains 
cas  des  lésions  thymiques. 


THE   NERVOUS   SYSTEM  1 5 

ternal  ophthalmoplegia,  changing  and  fleeting  paralyses  confined 
mostly  to  the  head  and  neck,  myasthenic  electrical  reaction  of 
Jolly  (muscular  fatigue  by  tetanizing  stimulation). 

3.  Thymoprivic  Idiocy  (Klose  and  Vogt).** 

4.  Tetany??  (Basch).5° 

4.  Suprarenals 

1.  Addison's  syndrome  and  suprarenal  insufficiency:  Asthenia, 
arterial  hypotension,  morning  nausea,  morning  vomitings,  lumbar 
pains,  melanoderma,  white  skin  reaction  of  Sargent,  amyotrophia,'^ 
aboulia,  sadness,  sometimes:  tetany,  epilepsy,  myoclonia^^  convul- 
sions, periodic  paralyses,  delirium,  mental  confusion,  coma,  sudden 
death. 

2.  Genito-suprarenal  syndrome:  Feminine  external  pseudo-her- 
maphrodism  with  virile  secondary  sexual  characteristics  ;  suprarenal 
masculinism  :  amenorrhea,  gynecomastia  (excessive  size  of  the  male 
mammary  glands),  adiposity  with  discolorations  of  the  skin,  all 
signs  of  feminine  maturity;  in  addition:  hypertrophy  of  the  clitoris, 
hypertrichosis  wtih  masculine  distribution,  masculine  voice,  increased 
muscular  and  nervous  tonicity,  violent  character,  "  disorders  of  the 
mental  state  and  afïectivity  may  go  as  far  as  sexual  inversion  "®' 
(Gallais);  increased  arterial  tension,  arteriosclerosis;  glycosuria. 
"  At  the  same  time,"  adds  Gallais,^*  "  bizarre  nervous  and  mental 
phenomena  set  in,  near  neighbors  to  maniacal  excitement.  The 
sexual  instinct  deviates  :  the  character  changes  and  becomes  violent, 
authoritative,  and  crises  of  anxiety  appear.  Along  with  these 
crises  and  in  the  interim  one  notes  vaso-motor  phenomena." 

5.  Paraganglia  of  the  Sympathetic 

Chromaffin  cells  in  the  solar  plexus,  Zuckerkandl's  aortic  para- 
ganglia, the  cardiac  paraganglion  of  Wiesel  and  Wiesner,  Luschka's 
carotid  gland,  Luschka's  coccygeal  gland,  the  tympanic  paragan- 

*^  Klose.  H.,  et  Vogt,  H.,  Klinik  und  Biologie  der  Thymusdruse  mit 
besonderer  Beriicksichtigung  ihrer  Beziehungen  zu  Knochen-  und  Nerven- 
system,  Beitrage  klin.  Chir.,  69,  p.  I,  et  Monographie,  Tubingen,  1910  (505). 

5°  Basch,  K.,  Ober  die  Beziehung  der  Thymus  zum  Nervensystcm,  Jahr- 
biJcher  fur  Kinderheilkunde,  68,  1908. 

^"^  Sézary,  Syndromes  surréno-musculaires,  Sem.  méd.,  5  fev.,  1913. 

^2  Laignel-Lavastine,  Les  formes  cérébrales  de  l'insuffisance  surrénal, 
Presse  méd.  d'Kgypte,  15  mars,  191 1,  p.  89. — Frette,  Th.,  1913. 

*' A.  Gallais,  Le  syndrome  génito-surrénal.    Thèse,  Paris,  1913. 

**  A.  Gallais,  Diagnostic  anatomo-clinique  du  syndrome  génito-surrénal, 
Revue  de  gynécologie,  janv.,  1914. — Voir  aussi  :  Truffier,  Virilisme  surrénal, 
Ac.  de  med.,  27  mai,  1914. 


l6  THE   INTERNAL  SECRETIONS  AND 

glion,  are  for  the  most  part^^  chromaffin  organs,  and  in  this  respect 
pertain  to  the  suprarenal  sympathetic  system.  Their  disturbances, 
from  the  standpoint  of  nervous  echoes,  have  not,  as  far  as  I  know 
at  the  present  time,  recognized  aspects  which  are  peculiar  to  them- 
selves. 

6.  Pancreas 

Diabetes  mellitus:  glycosuria,  polyuria,  polyphagia,  polydipsia, 
neuralgias,  pruritus,  impotence,  constipation,  scant  salivation,  scant 
perspiration,  dry  skin,  testicular  atrophy,  amenorrhea,  loss  of  tendon 
reflexes,  increased  arterial  tension,  asthenia,  headaches,  lessened 
resistance  to  cold,  perforating  ulcer,  syncopes,  attacks  of  apoplecti- 
form coma,  paralyses,  vertigoes,  asthmatic  dyspnea,  pseudo-an- 
gina pectoris,  sommolent  disorders  of  sleep,  depression,  apathy,  hy- 
pochondria, coma. 

7.  Pituitary 

1.  Froelich's  dystrophia  adiposo-genitalis  syndrome:  Adiposity, 
arrest  of  development  or  retrogression  of  the  genital  glands,  geni- 
tal organs  and  the  secondary  sexual  characteristics  corresponding 
thereto;  somnolence. 

2.  Renon  and  Delille's^^  syndrome  of  pituitary  insufficiency: 
Tachycardia,  instability  of  the  pulse,  lessened  arterial  tension,  in- 
somnia, anorexia,  painful  sensations  of  heat,  increase  in  the  secre- 
tion of  perspiration. 

3.  Acromegaly:  "Marked  hypertrophy,  not  congenital,  of  the 
upper  and  lower  extremities  and  of  the  head,"  pain  in  the  head, 
amenorrhea,  tendinous  reflexes  never  exaggerated,  arrhythmia,  syn- 
cope, sweats,  polyuria,  glycosuria,  lessened  resistance  to  cold, 
neuralgias,  acroparesthesias,  cramps,  lancinating  pains,  lassitude, 
irritability,  sadness. 

4.  Giantism:  "  Acromegaly  in  individuals  in  whom  the  epiphyseal 
cartilages  are  not  yet  ossified,"  impotence,  amenorrhea,  effeminacy, 
puerility,  aboulia,  asthenia,  glycosuria,  polyuria. 

5.  Diabetes  insipidus  (???)  :^^  Polyuria,  polydipsia. 

.^5  Voir  sur  ce  point  les  réserves  de  N.  Pende,  Patologia  de  l'apparecchio 
surrénale,  Milan,  1909;  de  C.  Frugoni.  La  gl.  carotidienne  possède-t-elle  une 
secret,  int.  propre?  Sem.  méd.,  9  oct,  1912,  p.  481  ;  de  Lanzillotta,  Archiv.  de 
Fisiologia,  i  sept.,  1913  ;  et  de  Laignel-Lavastine,  Pathologie  du  sympathetique 
(sous  presse). 

58  Rénon  et  Delille,  Congr.  de  méd.,  act.,  1907,  et  Delille  Thèse,  1909. 

S''  Il  tiendrait  à  un  trouble  du  lobe  intermédiare  de  l'hypophyse  et  de 
l'infundibulum.  Harvey  Gushing,  The  Pituitary  Body  and  Its  Disorders,  Lip- 
pincott  Co.,  Philadelphia  et  Londres,  1912;  mais  Camus  et  Roussy,  Soc.  de 
biol.,  1914,  passim,  l'ont  reproduit  expérimentalement  par  lésions  de  la  sub- 
stance grise  du  tuber  cinereum  au  voismage  de  l'infundibulum.  Il  desire  chez 
le  chien  tout  rôle  à  l'hypophyse  dans  la  détermination  du  diabète  insidipe, 
Presse  méd.,  8  juill.,  1914,  pp.  517-521. 


THE   NERVOUS   SYSTEM  I7 

8.  Pineal^^ 

1.  Macrogenitosomatosis:^^  Abnormal  increase  in  growth  or  size, 
premature  genital  and  sexual  development  with  secondary  sexual 
characteristics,  hypertrichosis,  precocious  exaggerated  mentality. 

2.  Pineal  adiposity :^°  Diffuse  obesity. 

9.  Choroidal  Plexus 

I.  Hydrocephalus:  Increased  tension  of  the  cerebro-spinal  fluid, 
rapid  reproduction,  nervous  and  mental  syndrome  of  ventricular 
hypertension,  clouded  mentality,  idiocy. 

10.  Ovaries 

1.  Infantilism:  Amenorrhea,  absence  of  secondary  feminine 
sexual  characteristics,  obesity,  scanty  hair,  puerility. 

2.  Acquired  ovarian  insufficiency:  Peripheral  vaso-dilatation, 
crises  of  subjective  sensations  of  heat,  sweats,  continuous  or  par- 
oxysmal tachycardia,  palpitations,  increased  arterial  tension,  in- 
somnia, headaches,  facial  neuralgias,  lumbago,  neuro-muscular 
asthenia,  uncertain  memory,  irritability,  nervous  debility,  hysterical 
crises,  exaggeration  of  the  sexual  instinct?,  which  is  more  often 
absent  or  inverted;  obesity,  inquietude,  anxiety,  phobias,  impulses, 
gastro-spasm,  constipation,  vomiting,  vertigoes,  syncopes. 

"Vagotonic  crises,"  before  the  periods  and  at  the  beginning  of 
pregnancy  :  pallor,  tendency  to  syncope,  spells  of  nausea,  vomiting, 
constipation,  lessened  arterial  tension,  rather  slow  pulse,  positive 
oculo-cardiac  reflex,  Samogyi's  sign,  psychic  depression,  related 
especially  to  the  evolution  of  the  corpus  luteum. 

One  must  not  confound  these  premenstrual  crises  or  crises  ot 
the  beginning  of  pregnancy  with  the  reactional  dyshyperthyroidism 
of  the  menopause,  characterized  by  hot  flashes,  sweats,  hyperten- 
sion, paroxysmal  tachycardia,  palpitations  and  anxiety. 

3.  "  Hyperovaria"  (Dalché)  i"^  Precocious  puberty,  abundant 
menses,  pain  during  and  before  the  first  day  of  the  periods,  inter- 
menstrual leucorrhea,  developed  sexual  instinct,  variability  of  de- 

^*  Dana  et  Berkeley,  W.,  Med.  Record,  10  mai,  1913;  L.  J.  Kidd,  Review 
of  Neurology  and  Psychiatry,  janv.-fev.,  1913,  pp.  1-24  et  55-75- 

'^  Ce  syndrome  de  Pellizi,  Ogle,  Oestreich  et  Slavyk,  Frankl-Hochwart, 
Gutzeit,  Hudovernig,  Raymond  et  Claude,  Alarburg,  A.  Collin  et  Hcuycr,  R. 
Neurol,  30  mai,  1914,  p.  729,  serait  lié  à  la  destruction  de  la  pinéale  par  une 
tumeur  chez  les  enfants.  Au  contraire,  par  Gallais,  la  pineale  semblerait 
avoir  une  rôle  fonctionnel  analogue  à  cclesi  de  la  cortico-surrénalc,  loc.  cit. 

•°  L'adiposité  pinéale  de  Marburg  serait  liée  à  un  "  hyperpinéalisme  "? 

«*  Dalché,  L'hyper,  et  l'hypovaric,  Gaz.  des  hôp.,  nos.  75  et  78,  1906.  Je 
préfère  dire  dyshypcrovarie. 


1 8  THE   INTERNAL   SECRETIONS   AND 

sire  depending  on  the  menstrual  period,  well-developed  eyebrows, 
thinness,  pallor,  large  hips,  rounded  contour  of  the  lower  extrem- 
ities, th-ï  size  of  which  contrasts  with  that  of  the  upper,  lessened 
arterial  pressure,  uneasiness  causing  movement  and  action,  nervous 
debility,  tendency  to  loquacity,  erotic  crises. 

11.  Testicles 

1.  Infantilism:  Lack  of  development  in  the  male  genital  organs, 
absence  of  secondary  sexual  characteristics,  obesity,  little  hair,  in- 
creased length  of  the  lower  extremities,  smallness  of  the  cranium, 
puerility. 

2.  Acquired  testicular  insufficiency:^^  Increase  in  size,  decreased 
hairiness,  rotundity  of  the  figure,  tendency  towards  obesity,  in- 
creased size  of  the  breasts,  loss  of  desire,  impotency,  senility,  in- 
creased arterial  tension?,  asthenia. 

The  types  of  testicular  insufficiency  are,  according  to  Rebattu 
and  Gravier:^' 

1.  The  sterile. 

2.  Eunuchoid  giantism,  because  the  internal  secretion  of  the  testicle 

was  of  late  appearance.  One  notes  in  such  a  case  a  prolonged 
infancy. 

3.  Eunuchism  by  castration,  characterized  by  giantism  and  a  youth- 

ful aspect.     The  secondary  sexual  characteristics  do  not  appear. 

4.  Revertive  infantilism  of  Gandy,  or  the  known  asexual  sort  of 

state,  with  attenuation  of  the  secondary  sexual  characteristics 
and  a  certain  degree  of  obesity,  due  to  delayed  testicular  dis- 
order in  the  adult. 

5.  Dyshyperdiastematosis  :    short    lower    extremities,    large    head, 

plenty  of  hair,  especially  heavy  moustaches,  thinness,  persist- 
ence of  youth,  no  arterial  hypertension,  activity,  moral  and 
physical  energy. 

12.  Prostate 

I.  Prostatic  insufficiency:  Asthenia,  diminished  potency,  neu- 
rasthenia, sometimes  suicide. 

_^2La  gerodermie  génito-dystrophique  de  Rumno  et  Ferrannivi  serait  au 
testicules  ce  que  le  myxoedème  acquis  est  a  la  thyroïde. 

^3  J.  Rebattu  et  L.  Gravier,  Étude  des  troubles  de  la  sécrétion  interne  du 
testicule.  Dissociation  des  secret  int.  et  ext.  du  testicule.  Retard  de  l'étab- 
lissement de  la  secret  int.  Nouv.  Iconographie  de  la  Salpêtrière,  juill.-août., 
1913,  pp.  257-271. 


THE   NERVOUS   SYSTEM  1 9 

2.  Prostatic  hypertrophy:^*  Increased  arterial  tension,^^  slowing 
of  the  heart  action,  cerebral  hemorrhage,  genital  excitement. 

B.     POLYENDOCRINE   SYNDROMES 

(a)    With  Predominance  of  the  Thyroid 

1.  Basedovians,  with  hypertrophy  of  the  thymus  and  vagotonic 
symptoms;  scleroderma  and  tetany,  amenorrhea;  Addison's  syn- 
drome ;  acromegaly,  etc. 

2.  Myxedematous  cases  with  hypertrophy  of  the  thymus,  tetany, 
acromegaly,  Addison's  syndrome,  amenorrhea,  infantilism,  hyper- 
trophy of  the  breasts,  etc. 

3.  Acromegalics  or  ovarian  insufficients  with  varied  disorders 
either  psychic,  nervous,  vaso-motor,  or  trophic,  entering  sometimes 
into  the  myxedematous  series  and  sometimes  into  the  Basedovian. 

(b)   With  Predominance  of  the  Ovary^^ 

1.  Thyroidal  reaction  to  the  ovarian  insufficiency:  tachycardia, 
palpitation,  sweats,  nervous  irritability,  vertigoes,  scanty  urination, 
tremors,  anxiety,  etc. 

"  One  can  no  longer  fail  to  notice,"  said  I  in  1908,  "  that  the 
differences  are  very  slight  between  these  nervous  manifestations 
and  the  picture  of  the  attenuated  forms  of  exophthalmic  goiter. 
This  pathogenetic  idea  allows  of  important  therapeutic  conse- 
quences. One  can  ask  if  it  would  not  be  of  interest  to  institute  an 
antibasedovian  therapeusis,  hemato-ethyroidin  for  instance,  against 
the  nervous  and  psychic  disorders  of  the  natural  menopause,  which 
recall  trait  for  trait  the  symptoms  of  the  Basedovian  series." 

Since  then  numerous  successes  of  the  sort  have  confirmed  the 
justice  of  the  idea. 

2.  Dyshyperovaria  among  cases  of  hypothyroidism:^^  antici- 
pation, prolonged  abundance  of  the  menses,  menorrhagia,  metror- 
rhagia. 

3.  Thyro-ovarian  disorders  taken  in  the  same  sense:  be  it  the 
ovarian  insufficiency  in  the  myxedematous  series,  or  the  dyshy- 
perovaria in  the  Basedovian  series,  in  all  cases  the  nervous  dis- 

8*  Elle  coïncide  souvent  avec  l'insuffisance. 

^=  L'extrait  prostatique  est  hypotenseur  et  cardio-modérateur,  Thaon.  Soc. 
de  biol.,  1.3  juillet,  1907.  Son  injection  est  suivie  de  vaso-dilatation  cérébrale. 
Ch.  Dubois  et  L.  Boulet,  Soc.  de  biol.,  19  avril,  1913,  p.  811. 

*^  Schickcle,  G.,  Kongrcss  f.  innere  med.,  191 1. 

''^  Leopold,  Levi  et  H.  de  Rothschild,  La  petite  insuffisience  thyroïdienne, 
1913,  p.  153- 


20  THE   INTERNAL   SECRETIONS  AND 

orders,  whatever  they  may  be,  of  the  dysthyroidal  women  are  mod- 
ified by  the  ovarian  rhythm  at  all  times 

(c)   With  Predominance  of  the  Pituitary 

1.  Infantile  giants  with  their  clinical  varieties  :  feminism, 
eunuchism,  crytorchidism,  pseudo-hermaphrodism  of  the  feminine 
type,  mental  puerility. 

2.  Acromegalics  with  deficiency  syndromes,  myxedema,  infanti- 
lism, amenorrhea,  obesity,  asthenia, 

3.  Acromegalics,  who  on  the  contrary  have  syndromes  of  hy- 
peractivity, more  or  less  vitiated  either  of  cooperation  or  supply: 
simple  or  exophthalmic  goiter,  arterial  hypertension  and  atheroma, 
lacteal  secretion. 

(d)   With  Predominance  of  the  Suprarenals 

1.  Addisonians  with  amenorrhea,  impotence,  chilliness,  tetany  or, 
on  the  contrary,  exophthalmic  goiter. 

2.  And  very  often  Basedovians,  acromegalics,  giants,  with 
spontaneous  glycosuria  of  alimentary  or  adrenal  type,  this  latter 
being  able  in  certain  cases  to  cause  one  to  presuppose  a  certain 
degree  of  suprarenal  activity. 

{e)  Without  Marked  Predominance 
Take  the  case  of  Claude  and  Gougerot  :  loss  of  sexual  character- 
istics, senile  face,  thick  skin,  wrinkles,  pigmentations,  chilliness, 
absence  of  perspiration,  asthenia,  lowered  arterial  tension,  tetany, 
atrophy  of  the  testicles,  of  the  prostate,  of  the  suprarenals,  thyroid 
and  possibly  of  the  parathyroids. 

In  order  to  include  these  nervous  disorders  revealed  in  the 
endocrine  syndromes  in  one  complete  aspect,  I  have  grouped  them 
together  under  five  headings,  motor,  sensory,  vegetative,  and  psy- 
chic disorders,  to  which  I  have  added  the  results  of  the  sympatho- 
vagotonic  tests. 

These  are: 

1.  Motility  (tonus,  sthenic,  reflex,  voluntary)  ; 

2.  Sensibility  (special,  general)  ; 

3.  Vago-sympathetic  : 

1.  The  sense  of  conscious  existence    (general,  hunger,  thirst, 

genital)  ; 

2.  Lisso-motility    (pupil,    vaso-motor,    pilo-motor,    chromato- 


THE   NERVOUS   SYSTEM  21 

motor,   lisso-motor   properly   speaking,   arterial   tension)  ; 

3.  Cardiac  rhythm  ; 

4.  Digestive   secretions    (salivary,  gastric,  hepatic,   pancreatic, 

intestinal),  cutaneous    (sweats),  urinary   (water,  sugar)  ; 
endocrinal. 

5.  Eutrophia.     General  good  nutrition. 

4,  Psychism  :   rhythm,   response,   emotion,   attention,   memory,   in- 

telligence, activity,  sleep,  instinct  (sexual). 

5.  Sympatho-vagotonic  tests  :  adrenalin,  atropine,  eserine,  pilocar- 

pine, oculo-cardiac  reflex. 

Now,  if  I  set  aside  the  sympatho-vagotonic  tests,  then  although 
it  is  very  easy  to  answer  plus  or  minus  to  different  questions  con- 
cerning the  nervous  state  just  analyzed,  when  one  considers  the 
thyroidal  syndromes,  it  is  impossible  to  do  the  same  clearly  for  the 
other  syndromes.  Those  which  furnish  most  of  the  definite  an- 
swers after  the  thyroidal  syndromes  are  the  ovarian  syndromes. 
One  single  functional  whole  is  affected  by  all,  that  is  a  sense  of 
well-being  (eutrophia)  ;  but  I  have  indicated  correctly  that  many 
of  the  disorders  allied  to  endocrine  dysfunction  may  be  independent 
of  the  nervous  system.  Whence  comes  this  first  affirmation,  that 
it  is  above  all  the  thyroid  syndromes  and  in  the  second  place  the 
ovarian  syndromes  that  are  most  frequently  accompanied  by 
nervous  disorders? 

There  is  therefore  an  enormous  difference  between  the  endocrine 
glands  viewed  from  the  nervous  consequences  resulting  from  their 
disturbances. 

Moreover  the  importance  of  the  thyro-ovarian  relations  ex- 
plains the  differences  according  to  sex  of  one  portion  of  the  neu- 
rology and  especially  of  the  psychiatry. 

If,  on  the  other  hand,  one  classifies  the  divers  groups  of  nervous 
disorders,  psychic  disorders  appear  to  predominate  in  the  thyroidal 
syndromes,  the  vago-sympathetic  disorders  in  the  thyroidal  and 
ovarian  syndromes,  and  finally  the  disorders  of  neuro-striated 
muscle  motility  predominate  in  the  thyroidal,  parathyroidal,  thymic 
and  suprarenal  syndromes.  Not  only  then  are  the  endocrine  syn- 
dromes far  from  being  equal  as  regards  wealth  of  nervous  ele- 
ments, but  in  addition  they  involve  a  relative  election  amidst  these 
elements. 

It  remains  to  discover  the  reasons  for  these  varieties  of  coin- 
cidence in  delving  further  into  the  probable  mechanism  of  their 
production. 


22  THE   INTERNAL   SECRETIONS   AND 

After  this  very  summary  account  of  the  facts,  let  us  consider 
their  interpretation. 

Among  the  nervous  symptoms — ^motor,  sensory,  vaso-motor, 
secretory,  trophic  and  psychic — revealed  in  the  enumerated  endo- 
crine syndromes,  all  the  world  admits  that  there  are  some  that  are 
caused  by  endocrine  disturbances  ;  thus  tachycardia  and  active 
vaso-dilatation  are  caused  by  thyroidal  disorders  in  Basedow's  syn- 
drome, as  are  asthenia  and  lowered  arterial  tension  by  suprarenal 
disorders  in  Addison's  syndrome.  These  glandular  disorders 
themselves  may  be  in  their  turn  secondary  to  a  nervous  disturbance. 
I  will  bring  to  your  notice  such  cases  in  the  succeeding  chapter. 
This  is  not  really  the  question.  The  endocrino-nervous  relation- 
ship is  demonstrated:  endocrinogenous  nervous  disorders  do  exist. 

Such  is  my  first  conclusion,  universally  admitted.  This  does 
not  mean  to  say  that  in  other  respects  all  the  nervous  symptoms 
existing  in  individuals  afflicted  with  an  endocrine  syndrome  are 
attached  to  this  syndrome  and  dependent  upon  the  glandular  dis- 
turbance of  which  it  is  the  expression.  In  addition,  among  the 
nervous  disorders  which  depend  upon  the  disturbance,  one  must 
differentiate  two  groups  according  as  to  whether  they  are  related 
directly  or  only  indirectly. 

The  direct  endocrino-nervous  relationships  have  numerous  ex- 
amples, both  clinical  and  experimental:  tachycardia  in  Basedovians, 
hypotension  in  Addisonians,  mydriasis  following  the  conjunctival 
instillation  of  adrenalin,  etc. 

The  indirect  endocrino-nervous  relationships  are  often  extremely 
difficult  to  outline  precisely,  and  it  is  in  their  study  that  one  part 
of  the  difficulties  of  the  question  lies. 

I  will  also  divide  these  relationships  into  four  categories. 

The  first  category  includes  the  indirect  endocrino-nervous  re- 
lationships through  evolutional  morphological  intervention.  Thus 
a  lesion  of  the  thyroidal  body  sustained  in  early  infancy,  even  in 
utero,^^  arrests  the  general  development  of  the  organism,  and  thereby 
interferes  with  the  appearance  of  secondary  sexual  characteristics 
with  all  their  consequences. 

The  glandular  disorder,  appearing  in  utero,  in  infancy  or 
adolescence  reacts  on  the  development  of  the  organism.  The  re- 
lationship comes  essentially  under  the  domain  of  ontogenesis  and 
morphology.     The  secondary  nervous  disorders  result  from  struc- 

^s  J.  Parhon,  "  Quelques  considérations  sur  l'importance  des  fonctions 
endocrines,  pendant  la  vie  embryonnaire  et  foetale  et  sur  leur  rôle  dans 
l'organogenèse,"  Presse  med.,  i*"  oct.,  1913. 


THE   NERVOUS   SYSTEM  23 

tural  anomalies,  which  are  themselves  secondary  to  the  glandular 
lesion. 

The  second  category,  near  neighbor  to  the  first,  includes  in- 
direct endocrino-nervous  relationships  through  humoral  morpho- 
logical intervention.  Thus  normally  the  suppression  of  the  ovarian 
function  at  the  menopause  entails  well-known  modifications  of  the 
female  organism,  the  exaggeration  of  which  determines,  among 
other  disorders,  trophic  symptoms  such  as  a  subcutaneous  adiposity 
and  development  of  hair.  This  example  may  also  serve  for  the 
comprehension  of  a  third  category:  the  indirect  endocrino-nervous 
relationships  through  a  humoral  intervention.  The  latter  are  ex- 
tremely frequent;  they  are  explained  very  naturally  by  the  func- 
tional correlations  under  the  influence  sometimes  of  the  hormones 
and  sometimes,  and  perhaps  more  often,  of  the  general  modifica- 
tions of  metabolism  (loss  of  calcium  for  example^^)  set  free  by 
the  glandular  disturbance  or  even  directly  by  the  cause  of  the  latter. 

For  example  increased  arterial  tension  among  Basedovians  seems 
to  be  allied  to  the  fact  that  their  blood  contains  more  adrenalin  than 
that  of  normal  individuals.  Asher  and  de  Rodt  explain  it  by  the 
fact  that  thyroidal  hypersecretion  reinforces  the  action  of  adrenalin  ; 
by  an  indirect  route  the  terminal  organs  of  the  sympathetic  may  be 
in  a  state  of  excitation,  and  as  the  secretory  nerves  of  the  supra- 
renals  belong  to  the  sympathetic,  an  increased  secretion  of  adrenalin 
may  result. 

Per  contra,  to  explain  the  tachycardia,  one  must  invoke  another 
factor  besides  the  experiments,  experience  teaches  only  that  the 
products  of  normal  thyroidal  secretion  augment  the  excitability  of 
the  autonomic  nerves. 

A  fourth  category  is  established  by  indirect  endocrino-nervous 
relationships  through  nervous  intervention.  This  intervention  is 
excited  at  times  physiologically  and  at  other  psychically.  In  the 
first  case  it  consists  for  example  of  headache  due  to  a  meningo- 
encephalic  vascular  disturbance  under  the  influence  of  a  cervical 
sympathetic  disorder  of  thyroidal  origin. 

In  the  second  case  it  consists  for  example  of  a  phobia  (fear  of 
dying,  of  having  heart  disease,  of  becoming  insane,  etc.)  determined 
by  a  diffuse  anxiety  allied  to  a  menopausal  tachycardia  from  excita- 
tion of  the  sympathetic  of  thyroidal  origin,  and  the  accuracy  of  this 
mechanism  is  shown  by  the  cure  of  such  cases  with  hemato-ethyroid- 
ine  (unpublished  personal  observations). 

•«Chiari  et  Frohlich,  Arch.  f.  exp.  Pathol,  u.  Parmak.,  ign,  P-  214. 


24  THE   INTERNAL   SECRETIONS   AND 

One  can  consider  this  last  group,  which  is  very  important  in 
psychiatry,  as  a  fifth  category,  and  speak  of  indirect  endocrino- 
nervous  relationships,  through  psychic  intervention.  These  rela- 
tionships simply  dogmatize  the  facts.  They  do  not  explain  them. 
The  Viennese  school  in  a  series  of  remarkable  studies  has  attempted 
to  interpret  them.  I  will  leave  to  my  co-worker,  Professor  Biedl, 
the  honor  and  pleasure  of  explaining  these  researches,  which  he 
partly  instigated,  and  which  he  has  had  the  wisdom  to  publish 
already  with  his  collaborators  and  pupils,  showing  admirable  com- 
mand of  the  subject. 

At  the  end  of  this  analysis  I  will  only  remark  that  if  the 
pharmacodynamic  division  of  Langley,  Eppinger  and  Hess  of  the 
vegetative  system  into  the  autonomic  and  sympathetic  systems  in- 
troduces in  its  own  interest  a  new  standard  in  the  nomenclature  of 
the  nerves,  up  to  now  based  on  anatomy,  and  that  if  it  is  better  now 
to  think  in  terms  of  physiology  rather  than  of  anatomy,  neverthe- 
less the  pharmacodynamic  idea  is  not  the  whole  of  physiology,  and 
the  three  present  divisions  of  the  vegetative  system  into  the  anatom- 
ical, physiological  and  pharmacodynamic  do  not  fit  their  valencies 
together  with  any  precision. 

In  a  parallel  manner  to  this  division  of  the  vegetative  system 
Eppinger,  Hess,  Falta  and  Rudinger  have  divided  the  endocrine 
glands  into  two  groups,  one  vagotrope  and  the  other  sympathi- 
cotrope.  As  I  have  already  stated  the  vagotropes  are  the  pancreas 
and  parathyroids,  and  the  sympathicotropes  are  the  thyroid  and  the 
adrenals,  to  which  Falta  and  Berterelli  have  added  the  infundibular 
portion  of  the  pituitary.  Now  the  analysis  of  nervous  disorders  in 
the  endocrine  syndromes  shows  moreover  that  the  vagotonic  and 
sympathicotonic  disturbances,  far  from  being  always  opposed  to 
each  other,  exist  at  times  in  the  same  individual,  not  only  con- 
secutively but  simultaneously,  and  accordingly  there  is  not  a  simple 
and  constant  relationship  between  the  endocrinal  disturbance  and 
the  nervous  disorder  of  one  or  the  other  group. 

Things  then  seem  much  more  complicated  than  one  would  have 
believed,  and  the  classifications  of  the  Viennese  School,  even  if 
they  have  rendered,  and  still  render,  great  service  in  arranging  the 
phenomena,  do  not  seem  as  yet  sufficiently  adequate  in  real  truth 
to  act  as  a  basis  for  new  systematizations. 


THE    NERVOUS   SYSTEM  2$ 

2.  Endocrine  Disorders  in  Nervous  Syndromes 
In  all  individuals  suffering  vi^ith  nervous  diseases  endocrine  dis- 
orders may  coexist  ;  but  I  will  only  outline  the  cases  in  which  these 
endocrine  disorders  may  be  under  the  direct  or  indirect  influence 
of  the  nervous  syndromes,  or  which  play  a  rôle  in  determining  the 
nervous  symptoms,  although  their  clinical  manifestations  are  not 
evident.  Following  this  point  of  view  I  will  divide  these  syndromes 
into  three  large  groups  :  sensory-motor,  vegetative  and  psychic. 

A.  Sensory-Motor  Syndromes 

Among  these  syndromes  there  are  a  great  number  that  can  have 
nothing  but  a  relationship  of  casual  coincidence  or  a  more  or  less 
mediate  attachment.  That  is  why  I  eliminate  the  hemiplegias, 
paraplegias,  ataxias,  muscular  atrophies,  vertigoes,  tremors,  athe- 
toses, choreas,  spasms,  myoclonias,  contractures,  convulsions,  myo- 
tonias, hypotonias,  myatonias,  neuralgias,  distributed  pains,  mi- 
graines, paresthesias  by  evident  organic  affections  of  the  nervous 
system,  with  known  lesions  of  the  nerves,  of  the  spinal  cord  or 
brain,  even  though  endocrinogenous  toxic  functional  nervous  dis- 
orders often  exist  coincident  with  nervous  symptoms  of  an  organic 
nature.  Certainly  as  bearing  on  the  subject,  for  example,  are  the 
hemiplegias  due  to  hemorrhage  of  the  optic  thalamus,  often  allied 
with  suprarenal  hypertrophies  (Frouin),  and  which  readily  appear 
to  be  due  to  increased  arterial  tension  secondary  to  dyshyperfunc- 
tion  of  the  adrenals;  in  like  manner  the  cerebral  hemorrhages  of 
the  menopause,  allied  also  to  ovarian  insufficiency  by  the  interven- 
tion of  sudden  hypertensive  shocks  in  the  vasomotor  ataxia  of  that 
critical  period;  as  well  as,  although  inversely,  increased  suprarenal 
secretion  by  excitation  of  the  splanchnic  in  the  course  of  tabetic 
crises  (there  are  endocrine  secretory  crises  just  as  there  are  exo- 
crine) ;  also  aspongiocytosis  in  these  same  suprarenals  subsequent 
to  the  incessant  motor  agitation  in  cases  of  chronic  chorea  or  mania 
(unpublished  personal  notes)  ;  also  those  tabetics  or  cases  of  syphilis 
of  the  nervous  system  with  myxedema,  infantilism,  tetany,  etc., 
caused  by  concomitant  syphilitic  lesions  of  the  nervous  system  and 
the  glands.  In  the  first  two  cases  the  relationhip  is  too  indirect  and 
mechanical  ;  in  the  two  following  the  relationship  is  inverse,  neurog- 
enous, direct  and  indirect;  in  the  last  the  coincidence  arises  from  a 
co-effect  of  the  same  cause,  namely  syphilis,  acting  on  two  different 
parts  of  the  bodv.  One  could  multiply  such  examples  without 
profit. 


26  THE   INTERNAL   SECRETIONS   AND 

I  will  retain  among  the  sensory-motor  syndromes  only  those 
whose  pathology  is  still  disputed,  and  which  appear  sufficiently  often 
in  coincidence  with  endocrine  disorders  for  the  hypothesis  of  a 
relationship  between  cause  and  effect  to  be  at  least  worthy  of 
discussion. 

Such  are 

1.  Certain  intermittent  paraplegias:  thyroid,  parathyroids,  thymus, 

suprarenals. 

2.  Periodic  paralysis  (Westphal). 

3.  Pseudo-paralytic  myasthenia  gravis  (Erb-Goldflam)  :''°  thymus, 

parathyroids. 

4.  Myopathies:''^  thyroid. 

5.  Certain  vertigoes  :  pituitary,  suprarenals,  ovaries. 

6.  Certain  tremors:  thyroid. 

7.  Certain  choreas  :  thyroid,  suprarenals. 

8.  Certain  spasms. 

9.  Certain  myoclonias. 

10.  Tetany:  parathyroids. 

11.  Parkinson's  syndrome :''2  parathyroids,  thyroid(?),  pituitary( ?), 

ovary  ( ?). 

12.  Epilepsy:  thyroid. 

13.  Eclampsia:  parathyroids. 

14.  Myotonias. 

15.  Congenital  myatonia. 

16.  Hypotonia. 

17.  Acroparesthesia. 

18.  The  cephalalgias:  thyroid,  ovary. 

19.  Migraine:  thyroid. 

20.  Certain  paresthesias. 

In  this  résumé  I  wish  to  state  that  the  sensory-motor  syndromes 
coming  under  the  precise  heading  of  the  chapter:  endocrine  dis- 
orders in  the  nervous  syndromes  have  not  been  described,  so  to 
speak,  but  I  have  nearly  always  indicated  nervous  syndromes  in 
which  endocrine  disorders  should  be  looked  for  in  order  to  under- 
stand them.  I  have  been  guided  therefore  more  by  the  relative 
symptomatic  importance  of  the  nervous  and  endocrine  manifesta- 
tions than  by  the  causal  relationship.     From  this  last  point  of  view 

'■o  Tobias,  Neurol.  Centralbl.,  May  i,  1913,  pp.  551-62. 

^1  Oppenheim,  H.,  Congrès  de  Londres,  1913. 

'^^  Sainton  et  Barré,  Soc.  de  Neurol.,  26  juin,  1913.  R.  N.,  15  juill.,  p.  55. 
Parhon  et  Goldstein,  Soc.  des  se.  mèd.,  Bucarest,  1909,  1910;  Encéph.,  cet., 
1912,  p.  228. 


THE   NERVOUS   SYSTEM  27 

I  must  distinguish  at  first  the  cases,  few  in  number,  where  the  endo- 
crine symptoms  are  caused  by  nervous  disorders,  such  as  the  endo- 
crine insufficiencies  described  recently  by  Claude,  in  the  train  of 
the  crises  of  Erb-Goldflam  myasthenia,  and  later  on  the  more 
numerous  cases  where  the  nervous  symptoms  are  caused  by  endo- 
crine disorders. 

This  subgroup  is  not  to  be  confounded  nevertheless  with  that 
of  the  nervous  disorder  in  the  endocrine  syndromes,  because  in  the 
latter  there  is  a  clearly  outlined  endocrine  syndrome,  while  in  the 
former  there  is  merely  an  endocrine  commotion.  If  they  are  con- 
founded owing  to  their  relationship  of  pathological  causality,  they 
are  to  be  distinguished  clinically  in  definite  types,  with,  in  addition, 
all  their  intermediates  between  them. 

This  having  been  stated,  two  remarks  arise  from  the  preceding 
résumé.  It  deals  especially  with  syndromes  having  paroxysmal 
manifestations  and  with  disorders  bearing  on  qualitative  variations 
of  motility. 

This  rôle  played  by  the  endocrine  glands  in  paroxysmal  nervous 
manifestations  did  not  escape  a  clever  clinician  like  Leopold  Lévi,'^* 
and  he  has  proposed  the  name  of  endocrinolepsies  for  such  paroxys- 
mal syndromes,  because  they  burst  forth  of  a  sudden,  like  an  ex- 
plosion (lepsy,  XaiJL^aveiv  to  seize)  and  they  are  subordinated  to  an 
endocrine  disturbance. 

The  principal  endocrinolepsies  are,  according  to  Leopold  Levi, 
ordinary  migraine  and  ophthalmic  migraine,  ordinary  asthma'^*  and 
nasal  asthma,  muco-membranous  enteritis,  urticaria,  relapsing 
edemas,  periodic  hydarthrosis,  acute  exacerbations  in  chronic  rheu- 
matism, paroxysms  of  gout,  crises  of  grayness  of  the  hair,  crises 
of  anxiety,  acute  paroxysmal  goiter. 

I  feel  that  I  can  add  certain  convulsive,  tetanic,  paralytic  and 
asthenic  crises. 

These  crises,  sudden,  variable,  relapsing,  subject  to  disappear- 
ance through  the  use  of  simple  organotherapy  (most  often  thy- 
roidal, sometimes  adrenal)  or  complex,  are  as  a  rule  dominated 
by  the  feminine  sexual  life. 

According  to  Leopold  Levi  the  endocrine  disorder  is  the  patho- 
logical mordant  which  sensitizes  centers  already  predisposed.     In 

^3  Leopold  Levi,  Endocrinolepsies,  leurs  characters  généraux,  Soc.  de 
méd.  de  Paris,  9  janv.,  1914,  pp.  44-47. 

''*  La  crise  hémoclassique  initiale  découverte  par  Widal  et  ses  collabora- 
teurs dans  l'asthme.  Rev.  méd.,  juill.,  1914,  comme  dans  l'urticaire  et 
l'hémoglobinurie  paroxystique,  Sem.  méd.,  1913,  n'élimine  pas  le  facteur 
nerveux  réactionnel  et  ses  connexions  endocaines. 


28  THE   INTERNAL   SECRETIONS   AND 

thyroidal  endocrinolepsies,  he  claims  a  hyperthyroidal  paroxysm 
which  activates  the  nervous  centers  by  a  local  vaso-motor  blast.  I 
might  state  with  equal  reason  that  it  is  a  general  law  of  the  nervous 
system  to  respond  in  intermittent  fashion  to  continuous  stimulation. 

Be  that  as  it  may  I  have  continued  to  insist  on  the  paroxysmal 
character  of  sensory -motor  syndromes,  such  as  tetany,  myasthenia, 
migraine,   which   seem  allied   with   endocrinal   disturbances. 

Secondarily  I  recall  that  the  schema  of  Lundborg,''^  open  to 
discussion  from  certain  viewpoints,  has  the  merit  of  synthesizing 
the  physio-pathology  of  the  thyroid  and  parathyroids  and  of  show- 
ing the  rôle  played  by  the  parathyroids  in  the  neuro-muscular  regu- 
lation. It  is  in  this  way  that  he  connects  tetany,  paralysis  agitans, 
myoclonia  (myoclonus,  epilepsy),  myotonia,  with  a  parathyroid  in- 
sufficiency, and  pseudo-paralytic  myasthenia  and  periodic  myatonia 
with  a  hyper  or  dysfunction  of  the  parathyroids. 

Tetany  is  alone  to-day  no  longer  in  doubt,  as  far  as  the  other 
afïections  are  concerned — it  is  nothing  but  an  hypothesis  as  yet. 
The  most  firmly  established  hypothesis  appears  in  relation  to  Park- 
inson's syndrome.  In  this  instance  as  Roussy  and  Clunet^®  state 
the  parathyroids  may  be  found  in  a  condition  of  hyperplasia.  As 
to  the  relation  of  this  condition  with  the  syndrome,  it  is  ignored.  It 
is  quite  possible,  according  to  Claude,''^  that  it  consists  of  a  simple 
reaction  of  defense  in  the  organism. 

B.  Vegetative  Syndromes 

In  this  enumeration  I  will  follow  the  plan  of  my  Pathology  of 
the  Sympathetic''®  now  being  published. 

(a)   Tegumentary  Syndromes 

1.  Local  syncope  of  the  extremities:  thyroid,  suprarenals,  kidney. 

2.  Acrocyanosis:  thyroid,  thymus. 

3.  Erythromelalgia  :  ovaries,  thyroid,  suprarenals.^^ 

4.  Acroparesthesia:  suprarenal. 

5.  Erythema:  thyroid. 

6.  Urticaria:  thyroid.®" 

^5  Lundborg,  Deutsche  Zeitschr.  f.  Nervenheilk.,  Bd.  XXVII,  1904,  p.  217. 

''^  Roussy  et  Clunet,  Arch,  de  méd.  exp.,  1910,  no.  3. 

'''"  H.  Claude,  Soc.  de  Neurol.,  fev.,  1910. 

[^  M.  Laignel-Lavastine,  Pathologie  du  Sympathique.  Esquisse  d'anatomo- 
physio-pathologie  clinique,  i  vol.  in-8  de  600  p.,  Paris,  Alcan,  1915? 

^9  Moleen,  G.,  Journ.  Amer.  Med.  Ass.,  17  août,  1912. 

^^  Les  modifications  sanguines  qui  précèdent  la  crise  d'urticaire,  ses 
rapports  avec  l'anaphylaxie,  sa  cause  déterminante  ramenée  par  Widal  et  ses 


THE   NERVOUS   SYSTEM  2g 

7.  Dermographia  :  thyroid. 

8.  Purpura  :  liver. 

9.  Pruritus:  liver,  kidney,  thyroid. 

10.  Melanoderma:  suprarenal,  thyroid. 

11.  Vitiligo. 

12.  Hyperidrosis  :  ovaries. 

13.  Chromidrosis. 

14.  Seborrhea:  thyroid(?),  testicles(  ?),  ovaries(?). 

15.  Goose  flesh:  thyroid (?). 

16.  Premature  grayness  of  the  hair:  thyroid. 

17.  Alopecia  :  thyroid.^^ 

18.  Hypertrichosis:  thyroid,  suprarenals,  testicles,  ovaries. 

19.  Zona  and  herpes. 

20.  Scleroderma:  thyroid. 

21.  Raynaud's  gangrene:  thyroid(?). 

22.  Acute  angioneurotic  edema  :  thyroid. 

23.  Trophedema:  thyroid (?),  pituitary (  ?). 

24.  Adiposity:  pituitary,  thyroid,  ovary,  pineal. 

(b)   Osteo-articular  Syiidrov.ics 
26.  Acromegalia  :  pituitary. 

(c)  Syndromes  of  the  Neuraxis 

29.  Syndromes  of  the  cervical  sympathetic:  thyroid (?),  suprarenal. 

31.  Mydriasis:  thyroid. 

32.  Myosis:  suprarenal (  ?). 

33.  Glaucoma. 

34.  Glittering  eye:  thyroid. 

35.  Exophthalmos  :  thyroid. 

36.  Migraine:  thyroid,  ovaries. 

37.  Cephalic  vaso-dilatation  :  ovaries  (?). 

38.  Epilepsy:  thyroid,  ovaries. 

39.  Vertigoes:  suprarenals,  ovaries,  thyroid. 

40.  Euphoria  :  thyroid. 

41.  Melancholia:  thyroid,  suprarenals,  ovaries. 

42.  Anxiety:  thyroid,  ovaries. 

élèves  (Widal,  Abrami  et  Et.  Brissaud:  L'auto-anaphylaxie,  Sem.  méd.,  24 
dec,  ÎQ13),  à  un  conflit  entre  colloïdes,  n'excluent  pas  l'importance  de  la 
thyroïde  dans  les  prédispositions  réactionnelles  et  les  manifestions  ncuro- 
cutantes. 

"  Sabourand,  Ann.  de  dermatol.,  mars,  1913. 


30  THE   INTERNAL   SECRETIONS  AND 

(d)  Circulatory  Syndromes 

43.  Vascular  spasms  :  suprarenals. 

44.  Increased  arterial  tension  :  suprarenals,  pituitary. 

45.  Vaso-dilatations  :  thyroid,  ovaries. 

46.  Arterial  hypotension  :  suprarenals,  pituitary. 

47.  Palpitations  :  ovaries,  testicles,  thyroid. 

48.  Tachycardia  :®2  thyroid,  ovaries. 

49.  Bradycardia:  pituitary (  ?). 

50.  Arrhythmia. 

51.  Cardiac  neuralgias. 

52.  Syncope:  thymus,  suprarenals. 

(e)  Respiratory  Syndromes 

54.  Asthma:  thyroid. 

56.  Acute  edema  of  the  lungs:  suprarenals. 

57.  Rhinorrhea. 

(/)  Digestive  Syndromes 

58.  Hypersalivation. 

60.  Gastric  crises. 

61.  Enteralgic  crises;  thyroid. 

65.  Digestive  atony. 

66.  Digestive  spasms. 

71.  Diarrhea. 

72.  Glycosuria:  thyroid,  suprarenals,  pancreas,  liver,  pituitary. 
78.  Constipation  :  thyroid,  pituitary. 

80.  Muco-membranous  entero-colitis  :  thyroid. 

(g)   Urinary  Syndromes 

84.  Polyuria:  pituitary (  ?). 

85.  Albuminuria. 

89.  Too  frequent  urination  :  thyroid. 

(h)  Genital  Syndromes 

95.  Impotency  :  prostate,  testicles. 

96.  Priapism:  suprarenals. 
98.  Ovarian  crises. 

ICI.  Frigidity. 

104.  Menstrual  troubles  :  thyroid,  ovaries. 

_^2  La  théorie  endocrine  de  la  tachycardie  paroxystique  a  été  exposée  par 
Savini  (Arch,  des  mal.  du  coeur,  nov.-dec,  1912).  J'en  ai  confirmé  l'au 
dernier  l'exactitude  chez  une  femme  à  la  ménopause  qui  quérit  par  opothérapie 
ovarienne. 


THE   NERVOUS   SYSTEM  jj 

(i)  Endrocrine  Syndromes 

105.  Basedow's  syndrome:  thyroid,  thymus. 

106.  Addison's  syndrome:  suprarenals. 

107.  Poly  endocrine  sympathetic  syndromes. 

(;')  General  Trophic  Syndromes 

108.  Hyperthermia  :  thyroid. 

109.  Hypothermia:  thyroid. 

111.  Diabetes  mellitus:  pancreas,  suprarenals. 

112.  Emaciation:  ovaries,  testicles,  thyroid. 

113.  Obesity:   thyroid,   pituitary,   pineal,   ovaries,   testicles. 

114.  Herpetism:  thyroid. 

All  these  vegetative  nervous  syndromes  are  the  functional  results 
of  very  different  causes.  Such  glands  as  I  have  marked  opposite  to 
them  simply  indicate  that  in  certain  cases  the  endocrine  disorders, 
which  have  been  noted  in  coincidence  with  the  nervous  disorders, 
have  played  a  rôle  in  the  determination  of  these  nervous  syndromes, 
or  that  inversely  the  endocrine  disorders  are  secondary  to  the 
nervous  commotions. 

In  fact  it  is  often  very  difficult  clinically  to  keep  from  confusing 
the  angio-tropho-neuroses  and  their  endocrinal  consequences  with 
the  endocrinopathies  and  their  vegetative  nervous  consequences. 

Quite  often  the  symptomatic  intricacy  and  the  paucity  of  chrono- 
logical and  established  data  are  such  that  one  is  forced  to  have  re- 
course to  a  synthetic  expression,  such  as  sympathosis,^^  which  I 
have  proposed,  and  which  simply  indicates  a  vegetative  nervous 
syndrome.  Among  the  univocal  sympathoses,  the  sensory,  circula- 
tory, lisso-motor,  secretory  and  trophic  sympathoses  constitute  the 
framework  for  the  preceding  facts.  I  must  call  attention  to  the 
considerable  rôle  that  these  vegetative  nervous  syndromes  play  in 
dermatology  in  their  vaso-motor,  secretory  and  trophic  types  and  in 
psychiatry  in  their  cenesthetic  and  vaso-motor  types. 

It  is  here  that  one  grasps  the  closeness  of  the  connections  be- 
tween the  internal  secretions  and  the  vegetative  nervous  system, 
and  one  understands  thereafter  the  interest  of  the  study  of  the 
sympathetic  and  the  vascular  glands  in  domains  like  dermatology 
and  psychiatry,^''  where  taken  clinically  they  still  conform  partly  to 
a  botanical  classification. 

83  Laignel-Lavastine,  Les  sympathoses,  Presse  méd.,  sept.  20,  1913. 
♦  Laignel-Lavastine,  Le  sympathique  et  les  viscères  dans  les  affections 
mentales,   Traite   mternat.   de   Psychol.-pathol.    Dans   ce   travail   je   montrais 
1  importance  de  ce  que  Munzer  nomme  très  hereusement  "  la  decentralization 
de  la  psychiatrie. 


32 


THE   INTERNAL   SECRETIONS   AND 


Just  as  I  have  laid  stress  elsewhere^'  on  the  rôle  of  the  sym- 
pathetic in  that  which  I  have  called  the  pathology  of  the  border 
made  up  of  those  humoral  reactions  or  reflexes  saddled  on  neurology, 
dermatology,  psychiatry,  visceral  medicine  and  the  pathology  of 
metabolism,  one  can  claim  that  there  is  a  whole  endocrino-vegeta- 
tive  chapter  still  to  be  written  in  dermatology,  as  in  digestive,  cir- 
culatory, respiratory,  urinary  and  mental  pathology. 

C.  Pyschic  Syndromes 

My  report^^  in  1908  at  the  Congress  of  Dijon  on  psychic  dis- 
orders due  to  disturbances  of  the  glands  of  internal  secretion,  the 
excellent  report  of  Professor  Parhon^^  at  the  Congress  of  Gand  in 
1913  on  the  glands  of  internal  secretion  in  their  relationship  to 
psychology  and  mental  pathology  and  the  recent  article  of  M.  Van 
der  Scheer®^  have  outlined  and  brought  out  the  question. 

In  order  to  avoid  criticism  I  refer  to  their  works  and  enumerate 
the  results  which  are  the  least  doubtful. 

(a)  Syndromes  of  Cerebral  Debility 

1.  Anencephalia :  suprarenals. 

2.  Idiocy    and    cranial    malformations:^^    thyroid,    parathyroids, 

suprarenals.®" 

3.  Imbecility. 

4.  Backwardness:®^  thyroid,  pituitary,  ovaries,  testicles,  thymus. 

5.  Mental  debility. 

6.  Psychic  imbalance.®^ 

(b)  Syndromes  of  Delirium 

7.  Mania  :®^  thyroid,  suprarenals,  ovaries. 

8.  Melancholia:  thyroid,  ovaries,  liver,  suprarenals,  kidneys,  pitui- 

tary. 

^''  Laignel-Lavastine,  Définition  du  sympathique,  Gaz  de  Hop.,  1912. 

88  Laignel-Lavastine,  Congrès  des  aliénistes  et  neurologistes,  Dijon,  1908. 

^'^  C.  I.  Parhon,  III*  Congrès  internat,  de  Neurol,  et  de  Psychiatrie, 
Gand,  1913. 

S8  W.  M.  Van  der  Scheer  (de  Meerenberg),  Die  pathogenetische,  Stellung 
der  Blutdrusen  in  der  Psychiatrie,  Jahresversammlung  der  Nederlansche 
Vereeniging  voor  Psychiatrie  en  Neurol.,  3  juill.,  191 3. 

8^  Bertolotti,  Presse  méd.,  2  mai,  1914,  p.  334. 

^°  Guilorowsky,  Influence  d'hypoplasie  surr.  sur  ce  cas  d'idiotie,  Congr. 
assist,  des  aliénés,  Moscow,  janv.,  1914,  Arch,  de  Neurol.,  mars,  1914,  p.  163. 

31  Hastings-Gilford,  Influence  des  glands  a  secret,  int.  sur  le  developp., 
Congr.  internat,  de  Londres,  1913,  sect,  de  Psychiatrie,  rapp. 

32  Cot.  Ch.  et  Dupin,  Insuff.  glandul.  et  anormaux,  Enceph.,  mars,  1913, 
pp.  223-34. 

"3  Lafora,  G.  R.,  Folie  manique  depressive  et  hyperthyroidisme,  Revista 
clin,  de  Madrid,  15  oct.,  1913,  pp.  294-301. 


THE   NERVOUS   SYSTEM  33 

9.  Mental  confusions:  liver,  kidneys,  thyroid,  parathyroids,  pan- 
creas, pituitary,  suprarenals,  ovaries,  testicles. 
ID.  Systematized  hallucinatory  deliria. 

11.  Systematized  deliria  without  hallucinations. 

12.  Genital  perversions:  ovaries,  testicles,  prostate,  suprarenals. 

(c)  Syndromes  of  Dementia 

13.  General  paralysis:  suprarenals,  thyroid,  pituitary,  etc. 

14.  Dementia  prsecox:®*  testicles,  ovaries,  pituitary. 

15.  Cerebro-arteriosclerosis  :  suprarenals,  testicles. 

16.  Senile  dementia:  parathyroids,  thyroid,  testicles,  ovaries. 

17.  Epileptic  dementia. 

{d)  N euro-psychic  Syndromes 

18.  Epilepsy:  thyroid,  parathyroids,  testicles,  ovaries. 

19.  Nervosism  :  thyroid. 

20.  Hysteria:  thyroid,  ovaries. 

21.  Neurasthenia:  suprarenals,  testicles,  ovaries. 

22.  Psychasthenia  :  thyroid,  ovaries,  testicles,  suprarenals. 

This  analysis  of  endocrine  disorders  investigated,  discovered  or 
supposed,  in  the  psychic  syndromes  allows  in  the  first  place  the 
conclusion  that  just  as  psychic  symptoms  are  met  with  frequently 
in  endocrine  syndromes,  so  are  endocrine  disturbances  indicated 
very  often  in  the  psychic  syndromes.  Moreover  one  should  state 
that  the  value  of  the  indicated  endocrine  disorders  is  very  uncer- 
tain, and  the  confirmation  of  a  clinical  endocrine  sign  or  glandular 
test  is  vastly  more  important  than  an  organotherapeutic  result  and 
above  all  more  important  than  the  existence  of  endocrine  lesions, 
because  we  know  the  utter  banality  of  all  these. 

The  frequency  of  pathological  endocrino-psychic  associations 
are  not  explicable  alone  by  fortuitous  coincidences  and  more  or  less 
mediate  attachments.  It  seems  to  me  necessary  to  admit,  in  cer- 
tain cases  at  least,  a  relationship  of  casuality.  This  conclusion 
which  I  advanced  in  1908  has  been  confirmed  by  numerous  authors, 
and  recently  by  M.  Parhon  in  1913.  This  relationship  of  casuality 
varies  moreover  according  to  the  case.  Eliminating  fortuitous 
coincidence  I  will  sum  up  in  a  few  lines  my  ideas  on  the  more  or 
less  mediate  bonds  between  endocrine  and  psychic  disorders,  on  the 
causal  rôle  played  by  the  psychic  syndromes  in  endocrine  disorders 

•*  Dercum  et  Ellis,  J.  of  Nerv.  and  Mental  Disease,  fev.,  1913,  pp.  73-90. 


34  THE   INTERNAL   SECRETIONS   AND 

and  on  the  causal  rôle  played  by  the  endocrine  disorders  in  the 
psychic  syndromes. 

I.  Relationships  of  Connection  between  Endocrine  and 
Psychic  Disorders 

In  this  heterogeneous  group  I  place  the  cases  in  which  the  fre- 
quency of  association  between  endocrine  and  psychic  disorders 
makes  one  think  that  it  consists  of  something  more  than  a  coin- 
cidence, and  in  which  nevertheless  one  can  not  demonstrate  a  clear 
relationship  of  casuality. 

Thus  psychic  excitations  give  rise  to  fits  of  rage  or  anxiety.  In 
a  similar  way  to  psychic  changes,  modifications  of  endocrine  secre- 
tion, thyroidal  for  example,  appear  to  me  to  be  among  the  factors 
that  make  up  that  physio-psychic  complex  called  emotion.  Some 
think  that  the  psychic  factor  is  causal,  others  like  Redmond  and 
Sauvage®'  think  that  "the  phenomenon  of  emotion  is  the  result  of 
auto-intoxication,  due  to  a  sharp  destruction  of  endocrine  equilib- 
rium." I  consider  that  the  mechanism  is  a  triple  one  :  at  times  the 
psychic  act  releases  the  secretory  act,  at  others  the  endocrine  act 
releases  the  psychic  act,  and  at  still  others  the  endocrine  and  psychic 
action  are  both  the  coresults  of  the  same  cause.  It  consists  of  a 
proximate  adherence. 

Take  for  another  example  a  given  case  of  juvenile  general 
paralysis  with  infantilism.  The  meningo-encephalitis  like  the 
atrophic  thyroidal  sclerosis,  being  the  results  of  hereditary  syphilis, 
are  both  coeffects  of  the  same  cause.  The  two  syndromes,  psychic 
and  endocrinal,  are  therefore  bonded  by  a  relationship  of  mediate 
adherence. 

2.  Causal  Rôle  of  the  Psychic  Syndromes  on  the  Endocrinal 

Disturbances 

In  the  normal  state  one  can  not  deny  that  psychic  excitations 
determine  disorders  of  secretion.  The  experiences  of  Dumas  and 
Malloizel  and  the  results  of  Cannon,  where  emotion  has  increased 
the  quantity  of  adrenalin  in  the  blood,  like  the  classic  case  of 
Trousseau  of  exophthalmic  goiter  caused  by  a  fit  of  rage,  are  in- 
stances of  the  kind. 

In  the  pathological  state  the  results  are  the  same  :  motor  agita- 
tion caused  by  delirium  may  bring  about  almost  complete  aspongio- 
cytosis  of  the  suprarenals,  as  I  have  had  occasion  to  observe  in  the 
insane.     It  is  therefore  plain  to  me  that  the  psychic  factor  may 

*'  Redmond  and  Sauvage,  Soc.  de  psychiatrie,  lo  f  ev.,  1913. 


THE   NERVOUS   SYSTEM  35 

bring  about  the  endocrinal  result.  INIoreover  the  psychogenic 
mechanism  of  endocrinal  disorders  is  not  uniform,  and  if  in  cer- 
tain cases  it  is  directly  psycho-secretory,  it  is  much  more  frequently 
indirectly  psycho-physio-secretory,  the  intermediary  perhaps  being 
the  physico-chemical  modifications  of  divers  viscera  of  life  of  rela- 
tionship or  of  nutrition. 

3.  Causal  Rôle  of  Endocrinal  Disorders  on  the  Psychic 

Syndromes 

This  rôle,  by  far  the  most  important,  is  not  always  uniform. 
One  can  diflferentiate  three  large  divisions  as  I  have  already  shown 
in  1908. 

1.  Sometimes  the  endocrinal  disorder  arising  in  utero,  in  in- 
fancy or  adolescence  reacts  on  the  development  of  the  organism 
and  the  brain:  the  psychic  disorders  result  from  anomalies  of 
structure. 

2.  At  others  the  endocrine  disorder,  compatible  with  existence 
and  a  relative  functionating  of  the  organism,  brings  about  in  organic 
as  well  as  psychic  life  more  or  less  reciprocal  modifications  of 
various  modalities. 

3.  At  still  others  the  endocrine  disorder  no  longer  moderate  but 
massive  produces,  along  with  grave  disorders  of  the  organism,  in- 
tense cerebral  reactions,  which  reveal  themselves  always  in  the 
same  way  by  classical  toxic  psychoses  of  the  mental  confusion  type. 

These  three  divisions  seem  to  me  to  explain  the  facts  of  the 
third  group  with  sufficient  connection. 

1.  The  first  is  the  most  simple.  It  remains  essentially  in  the 
domain  of  ontogenesis  and  morphology.  The  mental  puerility  of 
infantilism  is  an  example. 

2.  The  second  is  on  the  humoral  order.  The  internal  organs 
being  specifically  modified  by  the  elective  disturbance  of  one  or 
many  of  the  selected  internal  secretions,  the  anatomical  elements 
which  they  bathe  are  by  such  modified  in  their  vitality.  There 
result  accordingly  pathological  changes  along  with  somatic,  anatomic 
and  functional  alterations.  The  former  like  the  latter,  reflexes  of 
a  like  humoral  disorder,  present  a  debased  series  of  a  frank  pathol- 
ogy or  normal  model. 

With  greater  precision,  one  can  differentiate  with  Parhon  three 
varieties  in  the  humoral  action  of  the  endocrine  glands  on  the 
psyche. 

In  the  first  place  these  glands  directly  influence  the  nervous 


36  THE   INTERNAL   SECRETIONS  AND 

system  itself,  and  one  can  distinguish,  with  Munzer,  sympathico- 
tonic, vagotonic  (or  better  autonomotonic)  and  poly  tonic  glands, 
these  last  being  able  to  affect,  for  example,  the  cerebral  cortex, 
the  autonomic  system  and  the  sympathetic.  The  tonicity  of  one 
or  many  cortical  centers  being  influenced,  their  psychic  function 
will  thus  remain  the  same.  However,  this  psychic  function  will 
respond  equally  to  changes  in  the  cerebral  circulation,  the  state  of 
the  respiration,  the  oxidation  of  the  body,  and  the  chemical  com- 
position of  the  blood — for  example  the  richness  or  poverty  in  cal- 
cium salts,  etc.  Now  one  or  the  other  of  these  influences,  if  not  all, 
are  affected  by  the  sympathicotonic  or  autonomotonic  action  of  the 
endocrine  glands. 

Side  by  side  with  this  action,  more  or  less  directly  central, 
Parhon  claims  a  peripheral  action  "  which  moreover  may  be  itself 
partly  the  consequence  of  a  central  action  "  ;  it  is  the  action  of  the 
endocrine  glands  on  the  sense  of  conscious  existence. 

He  adds  that  "  the  action  of  the  genital  glands  must  acknowledge 
partly  at  least  a  similar  mechanism."  Finally  the  endocrine  glands, 
by  their  action  on  the  general  metabolism,  bring  about  modifica- 
tions of  different  tissues,  which  affect  the  psyche  through  humoral, 
nervous  reflex  or  psycho-cenesthetic  means. 

3.  "  Finally,  I  claimed,  the  third  mode  of  action,  the  massive,  of 
the  endocrine  disorders  on  the  mental  life,  which  is  characterized 
by  toxic  psychoses,  is  often  very  complex  in  the  sense  that  the 
cerebral  intoxication  is  not  only  the  result  of  the  disturbance  of 
the  incriminated  gland,  caused  by  the  concomitant  syndrome,  but 
the  result  of  a  series  of  associated  or  secondary  functional  in- 
sufficiencies. It  is  thus  that  in  cases  of  Addison's  disease  with 
delirium  the  discovery  of  azotemia  by  Sicard  and  Haguenau^" 
might  give  rise  to  the  hypothesis  that  renal  insufficiency  may  have 
been  added  to  the  suprarenal  insufficiency  in  the  mechanism  of 
delirium,  but  the  statement  must  be  made  that  the  determination 
of  azotemia  has  no  interest  unless  such  is  not  terminal,  because  of 
its  known  frequency  immediately  before  death.^^ 

In  a  word  the  endocrine  disorders  in  nervous  syndromes, 
whether  they  have  been  established  by  clinical  or  anatomical  methods 
or  induced  by  physiological  or  therapeutic  proofs,  are  face  to  face 
with  the  nervous  syndromes. 

1.  It  may  be  a  relationship  of  simple  fortuitous  coincidence. 

2.  It  may  be  a  relationship  of  more  or  less  mediate  adherence. 

88  Sicard  et  Haguenau,  Soc.  méd  des  Hop.,  15  mai,  1914,  p.  902. 
»7D.  Dumitresco  et  A.  Popesco,  Presse  méd.,  27  juin,  1914,  p.  487. 


THE   NERVOUS   SYSTEM 


37 


3.  It  may  be  a  relationship  of  causality:  at  times  the  nervous 
disorder  has  determined  the  endocrine  disturbance,  at  others  and 
inversely  it  is  an  endocrine  disturbance  which  has  determined  the 
nervous  syndrome,  but  the  frequent  clinical  latency  of  the  former 
may  interfere  with  the  comprehension  of  the  cause  of  the  latter. 

It  is  necessary  to  remember  that  to  a  patent  nervous  disorder 
there  is  frequently  attached  a  latent  endocrine  cause.  One  should 
therefore  look  for  an  endocrine  cause  in  any  nervous  syndrome  of 
an  unknown  or  obscure  origin.  But  one  must  not  be  determined 
to  find  such  in  spite  of  everything,  and  to  accept  contingencies  for 
necessities. 

In  conclusion,  all  the  facts  gone  over  in  this  critical  review  are 
explained  aside  from  coincidence  and  coefifects  of  the  same  cause, 
at  times  by  a  direct  or  indirect  endocrino-nervous  relationship 
through  a  morphological  intermediary  (evolutional  or  humoral) 
or  a  physiological  intermediary  (humoral  or  nervous)  or  a  psychic 
intermediary,  at  others  by  a  direct  or  indirect  neuro-endocrinal 
relationship  through  a  direct  morpho-evolutional,  physiologic  reflex 
or  psychic  intermediary  or  through  the  same  indirectly  (motor  ac- 
tivity, general  nutrition),  and  at  still  others  by  recurring  endocrino- 
neuro-endocrinal  relationships  and  neuro-endocrino-psychic  rela- 
tionships. 

This  is  explained  in  the  following  table. 


Coincidence. 

Connection. 

Causality. 


Endocrino-nervous  Relationships 
fProximate. 


LMediate. 


I.  Simple. . .  - 


2.  Double 


...{ 


Endocrino-nervous. 
(i)  Direct. 


(2)  Indirect  through  _ 
intermediaries. 


Neuro-endocrinal. 
(i)  Direct. 


Morphologic  evolutional. 
Morphologic  humoral. 
Physiologic  humoral. 
Physiologic  nervous. 
Psychological. 


(2)  Indirect  through 
intermediaries. 


Morphologic  evolutional. 
Physiologic  reflex. 
Psychologic. 
Motor  activity. 
General  nutrition. 

Endocrino-neuro-endocrinal. 
Neuro-endocrino-nervous. 


38  THE   INTERNAL   SECRETIONS   AND 

B.   Endocrino-Neurological  Sketch 

In  practice,  that  which  matters  is  less  the  neurogenous  endo- 
crine disorders  than  the  endocrinogenous  nervous  disorders. 

Of  course  the  endocrine  disorders  secondary  to  the  nervous 
disorders  are  very  interesting  theoretically  and  practically.  Theo- 
retically they  show  the  unity  of  human  personality  and  not  only 
the  influence  of  nervous  disorders  on  the  secretions  and  nutrition, 
but  in  addition,  to  use  an  old  expression  which  illustrates  the  pic- 
ture, the  mastery  of  the  soul  over  the  body. 

Practically  their  interest  is  twofold,  because  attenuated  and 
masked  by  the  nervous  syndrome,  they  may  nevertheless  modify 
and  complicate  it,  as  can  be  seen  in  certain  tabetics  and  general 
paralytics.  Inversely  when  very  marked  they  may  mask  more  or 
less  through  their  symptomatic  richness  the  clinical  expression  of 
the  nervous  disorders  which  cause  them,  and  thus  effect  a  change 
with  an  endocrine  syndrome  which  is  clinically  primitive.  This  is 
the  case  in  certain  Addisonian  and  Basedovian  syndromes,  which 
are  not  originally  endocrinogenous  but  neurogenous. 

Endocrinogenous  nervous  disorders,  which  are  infinitely  more 
frequent  than  neurogenous  endocrinal  syndromes,  form  altogether 
an  extremely  important  group,  which,  unburdened  with  morphologic 
and  endocrinogenous  trophic  syndromes  in  which  a  nervous  factor 
is  not  constant,  constitute  the  greater  part  of  functional  neurology. 

I  intend  in  this  sketch,  as  a  practitioner,  to  limit  myself  almost 
entirely  to  that  which  functional  neurology  owes  to  endocrinology. 

I  will  take  my  illustrations  from  certain  ordinary  symptoms, 
endocrino-vegetative  syndromes,  traditional  psychoneuroses,  temper- 
aments and  characters. 

I.   Ordinary  Symptoms 

Among  the  ordinary  symptoms  I  retain  arbitrarily  asthenia, 
headache,  insomnia,  anxiety,  sweats,  constipation,  arterial  hyperten- 
sion and  obesity  in  order  to  show  that  there  are  for  each  of  these 
symptoms  certain  cases  which  arise  from  an  endocrinal  cause,  and 
that  daily  one  should  give  an  endocrine  factor  consideration  in 
pathogenic  diagnosis.  It  should  be  considered  but  not  determined 
upon  except  on  the  authentication  of  well-marked  signs,  that  is  to 
say,  clean  cut  and  frank.  Moreover  most  frequently  such  con- 
sideration ends  in  elimination. 


THE   NERVOUS   SYSTEM  39 

(i)  Asthenia 

Asthenia  is  abnormal  fatigue.  It  is  either  general  or  more  espe- 
cially motor  or  psychic. 

Motor  asthenia  is  an  extremely  commonplace  symptom,  due  to 
various  causes,  either  infectious,  toxic  or  psychic. 

Among  the  motor  asthenias  of  endocrinal  origin,  the  first  to  be 
recognized  was  the  asthenia  of  Addison's  disease.  It  is  connected 
with  adrenal  insufficiency,  and  is  accompanied  by  arterial  hypo- 
tension. 

In  addition  there  are  motor  asthenias  allied  with  adrenal  insuffi- 
ciency, which  are  not  Addisonian.  This  fact  is  well  known  to-day. 
They  are  very  common  and  are  usually  but  not  always  accompanied 
by  arterial  hypotension. 

Their  recognition  and  consequently  their  organotherapeutic  treat- 
ment will  permit  the  cure  of  a  large  number  of  sick,  ticketed  as  neur- 
asthenics, cyclothymics,  melancholies  and  even  hypochondriacs. 
Certain  cases  of  arteriosclerosis  with  hypotension  enter  into  this 
category.  The  interesting  point  is  that  they  were  often  asthenics 
already  at  the  beginning  of  their  arteriosclerosis,  while  they  still 
had  hypertension.  This  asthenia  of  hypertensive  arteriosclerotics 
existing  from  the  beginning  is  well  understood  to-day.  Maurice  de 
Fleury  among  the  first  has  shown  its  frequency.  In  such  cases  there 
is  often  a  dyshyper functionating  of  the  suprarenals.  This  asthenia 
of  hypertension  through  dyshyperfunction  may  be  recovered  from 
completely  through  a  simple  regime.  It  can  after  a  period  of  years 
border  on  asthenia  due  to  adrenal  insufficiency,  an  insufficiency  itself 
secondary  to  the  old  glandular  hyperf unction  and  without  mechanical 
participation  of  cardiac  insufficiency  ;  I  have  followed  a  lot  of  such 
cases  in  the  last  ten  years. 

The  majority  of  endocrinogenous  muscular  asthenias  are  supra- 
renal, but  there  are  others  which  are  thyroidal,  thymic,  parathyroidal, 
pituitary,  ovarian,  testicular  and  polyglandular. 

Dejerine  and  Gauckler^»  have  brought  the  weight  of  their  au- 
thority to  the  support  of  these  data. 

The  endocrinal  origin  of  a  muscular  asthenia  having  been  recog- 
nized, diagnosis  is  not  complete.  The  cause  must  be  determined. 
In  the  simple  cases  it  is  sometimes  an  infection  (a  beginning  tuber- 
culosis, convalescence  from  grip  or  diphtheria,  etc.),  at  others  an  in- 
toxication. In  the  more  complicated  cases  it  is  a  vascular,  nervous 
or  psychic  disturbance,  under  the  subjection  itself  of  a  previous  endo- 

»«  Dejerine  et  Gauckler,  Les  asthénies  périodiques  crises  de  fatigue.  Presse 
méd.,  17  juin,  1914,  PP-  457-459- 


40  THE   INTERNAL   SECRETIONS   AND 

crinal  disorder.  It  is  often  like  this  in  the  hypophysics  of  Martinet/^ 
a  typical  case  of  which  I  have  actually  seen,  which  merits  publica- 
tion by  itself. 

An  important  fact  is  that  the  asthenia  may  be  not  the  result  but 
the  cause  of  an  endocrinal  insufficiency.  Claude^"''  believes  this  to 
be  the  case  in  the  paralytic  myasthenia  of  Erb-Goldflam.  According 
to  him  the  endocrine  glands  are  normal  or  rather  increased  in  size, 
but  they  are  exhausted  by  an  effort  truly  excessive.  This  is  brought 
about  by  the  entrance  into  the  circulation  of  poisons  to  the  nerve  and 
muscle  cells  of  inconstant  origin,  but  which,  in  certain  cases,  arise 
from  a  disordered  thymus.  In  the  Erb-Goldflam  syndrome  the  mul- 
tiple insufficiency  of  the  endocrine  glands  by  functional  exhaustion 
is  therefore  secondary,  just  as  the  disappearance  of  spongiocytes  in 
the  suprarenal  cortex  is  secondary  to  an  intense  or  prolonged  mus- 
cular agitation.  I  have  had  occasion  to  confirm  in  eight  cases  this 
fact  grasped  experimentally  by  Mulon"^  and  clinically  by  Porak.^"^ 

(2)  Headache 

Not  only  migraine,^"^  but  the  most  ordinary  headache  may  be  of 
endocrinal  origin.  Many  of  the  headaches  called  neurasthenic  come 
under  this  heading.  The  most  frequent  of  the  endocrinogenous 
headaches  are  those  of  thyroidaP°*  origin.  As  a  general  thing  slight 
concomitant  signs  of  hypothyroidism,  such  as  palpebral  edemas, 
anorexia,  constipation,  somnolence,  chilliness,  muscular  and  articular 
pains  assist  the  diagnosis  ;  but  sometimes  the  thyroidal  disorder  does 
not  reveal  itself  except  by  the  headache,  which  of  itself  and  through 
causal  elimination  should  possess  an  indicative  value.  These  head- 
aches are  very  frequent  among  women;  are  more  or  less  governed 
by  genital  life,  improved  by  sexual  relations^"^  and  cured  by  preg- 
nancy.   I  have  gathered  typical  cases  of  the  kind  in  my  practice. 

^^  Martinet,  Syndrome  hyposphyxique,  Pr.  méd.,  21  dec,  1912.  S. 
hyposphyxie  et  insuff.  plurigland.,  Ac.  de  méd.,  22  avril,  1913,  et  Pr.  méd.,  2 
août,  1913. 

i°<*  H.  Claude,  La  myasthénie  paralytique  et  les  syndromes  asthéniques 
par  insuffisance  surrénal,  Acad.  de  méd.,  9  juin,  1914,  et  Soc.  de  Neurol.,  28 
mai,  1914.    R.  N.,  15  juin,  p.  786. 

101  Mulon,  P.,  Soc  de  biol.,  26  juill.,  1913,  p.  189. 

i°2  Porak,  Mém.  inéd. 

103  Leopold  Levi  et  H.  de  Rothschild,  Acad.  de  méd.,  14  nov.,  1911,  p.  22; 
Répertoire  de  méd.  int.,  mars,  1912;  Goett,  La  migraine  thyroïdienne.  Th. 
Bordeaux,  1909.  Flatau,  La  migraine,  Berlin,  1912;  A  Véron,  id..  Th.  Lyon, 
1914. 

^°*  Gaujoux,  Céphalée  hypothyroïdienne  et  opothérapie,  Soc.  des  Se.  méd. 
de  Montpellier,  14  mars,  1913;  Bilancioni,  G.,  Il  Policlinico,  sez.  pratica,  23 
mars,  1913,  pp.  401-6. 

105  Migraines  de  jeunes  filles  guéries  par  le  mariage,  migraines  de  jeunes 
femmes  absentes  le  lendemain  de  l'accomplissement  des  devoirs  conjugaux. 


THE    NERVOUS   SYSTEM  4I 

After  the  thyroidal  types,  the  ovarian,  testicular,  pituitary,  supra- 
renal and  polyendocrinal  headaches  are  to  be  noted. 

(3)  Insomnia^°^ 

Among  the  insomnias  those  of  Basedow's  syndrome  and  the 
menopause,  which  come  under  the  heading  of  dyshyperthyroidism, 
show  the  existence  of  endocrinogenous  insomnias. 

The  most  frequent  of  these  is  the  dyshyperthyroidal,  seen  clearly 
in  the  cases  that  I  have  just  cited.  It  is  probably  present  in  many 
of  the  psychoses,  where  one  knows  that  thyroidal  excitation  is  fre- 
quent. It  is  to  be  suspected  at  least  in  the  "  nervous  "  where  no  other 
appreciable  cause  justifies  its  presence. 

The  insomnia  of  acquired  ovarian  insufficiency  seems  to  contra- 
dict this  precedent. 

Perhaps  it  conforms  to  the  same  lines  as  the  insomnia  of  certain 
cases  of  hypertension  of  the  fifties,  where  the  genital  functions  are 
lessened. 

(4)  Anxiety 

The  anxiety  of  Basedovians  and  of  many  women  at  the  meno- 
pause and  its  cure  by  hematothyroidin,  confirmed  many  times  by 
Alquier,  Rose,  myself  and  many  others,  show  the  existence  of  endo- 
crinogenous anxiety  due  to  dyshyperthyroidism.  This  anxiety  seems 
really  to  be  that  of  the  anxious  melancholias.  It  is  already  known 
that  the  works  of  Parhon  tend  to  show  the  rôle  played  by  the  thyroid 
in  what  he  calls  the  affective  psychoses.^"'' 

The  anxiety  frequently  noted  in  acquired  ovarian  insufficiency 
seems  to  be  controlled  by  the  same  mechanism. 

Clinically  considered,  all  anxiety  that  does  not  possess  warrant 
should  make  one  suspicious  of  an  abnormal  excitation  of  the  thyroid. 

(5)  Sweats 

A  vagotonic  reaction,  released  by  pilocarpine,  arrested  by  atro- 
pine, the  sweats  which  come  on  in  crises  at  the  menopause,  are  asso- 
ciated in  the  hot  flushes  with  active  vaso-dilatation,  but  may  be  pres- 
ent alone.  Symptomatic  in  this  instance  altogether  of  acquired 
ovarian  insufficiency  and  of  thyroidal  reaction,  they  are  seen  in  the 
two  conditions.  We  are  all  familiar  with  the  frequent  sweats  of 
Basedovians. 

^0"  A.  Salmon,  La  fonct.  du  sommeil,  Vigot,  iQio. 

"^^  Cette  voie  permettra  peut  être  de  trouver  des  raisons  aux  intermit- 
tences de  toutes  des  syndromes  d'excitation  et  de  dépression,  maniaques  et 
mclancholiques. 


42 


THE   INTERNAL   SECRETIONS   AND 


According  to  this  there  are  endocrinogenous  sweats  due  to 
dyshyperthyroidism.  This  vagotonic  expression  referable  to  thy- 
roidal excitation  is  associated  very  often  with  sympathicotonic  mani- 
festations of  a  similar  origin.  It  is  thus  in  the  classical  hot  flushes 
of  the  menopause. 

(6)  Constipation 

Spastic  constipation,  "vagotonic,"  which  yields  to  belladonna,  is 
a  nervous  symptom. 

Its  recognition  in  cases  of  hyperchlorhydria,  in  certain  neu- 
rasthenics, in  women  at  the  menopause  or  at  the  beginning  of  preg- 
nancy, permits  of  cures  as  easy  and  complete  as  they  are  brilliant, 
through  the  use  of  the  well-known  belladonna  pillule  of  Trousseau 
and  Pidoux. 

Then  again  it  is  frequently  caused  (by  ovarian  or  testicular  in- 
sufficiency with  abnormal  excitation  of  the  thyroid,  as  seen  in  the 
observations  of  Maranon.^"^ 

This  constipation  must  be  carefully  distinguished  from  the  con- 
stipation of  myxedema,  from  the  general  type  of  constipation,  such 
a  common  sign  of  hypothyroidism,  and  which  is  cured  by  organo- 
therapy. 

Thus  the  same  symptom  in  its  gross  clinical  expression  may  be 
of  thyroidal  origin,  and  point  nevertheless  to  two  different  mechan- 
isms, excitation  or  insufficiency  of  thyroidal  secretion.  This  instance 
of  thyroidal  constipations  is  not  the  only  example  o^  endocrinogenous 
constipations  that  can  be  given.  There  appears  to  be  one  also  of 
pituitary  origin,  although  the  cure  of  certain  atonic  constipations  by 
the  extracts  of  the  posterior  lobe  of  the  pituitary  does  not  demon- 
strate the  nature  of  this,  inasmuch  as  these  extracts  act  as  excitants 
of  unstriped  muscle  tissue  by  virtue  of  their  pharmaco-dynamic 
properties,  and  not  on  account  of  their  elective  vicarious  or  stimu- 
lating^"^ action  on  the  pituitary. 

(7)  Arterial  Hypertension 

To  Vasquez  belongs  the  credit  for  having  described  in  man  "  ar- 
terial hypertension  due  to  hypersecretion  of  the  suprarenals,"  which 
Josué  confirmed  by  experiments.  In  advance  of  this  permanent 
hypertension,  hyperadrenal  secretion  may  show  itself  through  hyper- 
tensive crises,  which  have  been  classical  since  the  time  of  Pal.  More- 
over, there  are  other  hypertensive  crises  besides  the  endocrinogenous, 

los  Maranon,  G.,  Hyperchlorhydrie  et  hyperthyroidism,  Revue  de  méd., 
10  mars,  1914,  pp.  161-83. 
109  Hallion,  loc.  cit. 


THE   NERVOUS   SYSTEM 


43 


and  among  the  latter  others  besides  those  due  to  hyperadrenal  secre- 
tion. Those  which  are  alHed  with  disturbances  of  the  pituitary, 
ovary,  testicles,  prostate,  thyroid  and  parathyroids,  have  been  recog- 
nized. In  like  manner  there  are  permanent  arterial  hypertensions 
which  are  not  endocrinogenous,  and  among  the  latter  some  which 
are  not  of  suprarenal  origin. 

There  is  no  need  to  continue.  I  have  simply  tried  to  show  that 
there  are  arterial  hypertensions  which  are  nervous  endocrinal  syn- 
dromes, because  they  depend  upon  a  vascular  spasm,  of  endocrinal 
origin. 

(8)  Obesity 

The  existence  of  endocrinogenic  obesities  is  no  longer  a  matter 
of  dispute.  Mouriquand""  has  described  them  well  recently  in 
children. 

I  have  reported  several  cases  myself  this  last  year.^^^ 
The  only  point  of  interest  is  the  demonstration  of  a  nervous 
factor  in  the  determination  of  these  endocrinogenic  obesities.  In 
the  majority  of  cases  I  do  not  think  that  this  exists,  but  believe  that 
such  obesities  arise  through  humoral  disturbance  of  endocrinal 
origin.  Nevertheless  a  nervous  factor  is  present  in  the  cases  noted 
where  a  cerebral  tumor  gives  rise  to  obesity  through  pressure  on 
the  pituitary.  One  might  also  suspect,  if  not  prove,  a  nervous  factor 
in  those  cases  of  segmentary^^-  or  paraplegic  disposition  of  adipose 
tissue.  I  have  with  Viard  reported  a  case  of  this  type,  which  corre- 
sponding to  a  trophedema  of  Henry  Meige,  studied  previously  with 
M.  Sicard,"^  caused  me  to  view  in  their  entirety  "the  variations  of 
the  panniculus  adiposis,  according  to  the  divers  physiological  condi- 
tions— of  infancy,  puberty,  pregnancy,  lactation,  castration,  and  of 
the  menopause — and  to  pathological  conditions — of  the  simple  or 
associated  endocrinal  syndromes,  thyroidal,  pituitary,  ovarian,  tes- 
ticular, suprarenal,  and  parathyroidal— pursuant  to  their  relations 
with  the  trophedema  of  Henry  Meige,  the  adiposis  dolorosa  of  Der- 
cum,  the  intermédiate  afïections  between  these  two  syndromes,  to 

'»"  Mouriquand,  Congres  de  Pédiatrie,  Rapp.,  1913. 

"/  Laignel-Lavastine  et  L.  Boudon.  Obésité  par  sarcome  juxta-hypo- 
physaire.  Soc.  méd.  des  hop.,  13  fev.,  1914;  Laignel-Lavastine  et  Pitulesco, 
Obésité  familaile  avec  perturbations  endocrines,  id. 

"2  Sicard  et  Berkowitsch,  Adipose  doul.  par  insuff.  ovarienne,  Gaz.  des 
Hop.,  1908,  p.  848;  Claude  ct  Sézary,  Adip.  doul  aet  remarquable  de  I'opoth. 
rhyr..  Gaz.  des  Hop.,  1Q13,  No.  86,  p.  69;  Ivanoff,  Mai  de  Dercum,  R.  russe 
de  Psychiatrie,  mars,  1913;  Wcbcr,  Parks,  Lipodystrophie  progressive;  R. 
Hirschfeld,  in  Handbuch  dcr  Neuro.  de  Lewandowsky,  Bd.  IV,  pp.  455-71. 

"■' Sicard  et  Laignel-Lavastine,  Un  cas  de  trophoedcme  acquis.  Soc.  de 
Neurol.,  15  janv.,  1903,  Nouv.  Iconographie  de  la  Salp.,  janv.,  1903. 


44  THE   INTERNAL   SECRETIONS   AND 

certain  states  of  hardening  of  the  skin  associated  with  various  affec- 
tions of  the  central  nervous  system,  or  of  the  sympathetic  or  of  the 
ductless  glands,  and  the  part  which  relates  in  their  genesis  to  dis- 
turbances of  nutrition  in  general  and  the  endocrine  system  and  the 
sympathetic  in  particular."^^* 

2.  Endocrine-sympathetic  Syndromes 

I  will  only  retain  from  among  the  above-mentioned  syndromes 
exophthalmic  goiter,  Addison's  syndrome,  scleroderma  and  diabetes 
mellitus  by  reason  of  their  double  interest,  which  is  both  doctrinal 
and  practical,  and  of  the  large  number  of  studies  that  they  have  oc- 
casioned, and  are  still  causing  every  day. 

(i)  Basedow's  Syndrome 

I  have  nothing  to  say  concerning  the  immense  bibliography  of 
exophthalmic  goiter,  for  which  I  refer  you  to  Biedl's  work  on  the 
subject  and  the  recent  report  of  Roussy  at  the  Congress  of  Luxem- 
bourg (August,  1914).  I  will  simply  state  that  instead  of  taking 
sides  for  the  thyroidal  theory  whose  last  favorable  pleading  v/as 
sustained  with  excellent  arguments  by  Roussy  and  Clunet,^^^  or  for 
the  sympathetic  theory  defended  by  Gley  and  Cleret,^^^  with  the  aid 
of  arguments  drawn  from  experimental  and  anatomo-clinical  facts, 
one^^^  of  which  is  personal  to  myself,  I  prefer  to  say  that  it  is  the 
same  with  Basedow's  syndrome  as  with  all  the  endocrino-sympathetic 
syndromes,  that  they  are  all  the  expressions  of  a  disturbance  of 
function,  and  that  this  function  is  disordered  as  well  by  a  glandular 
lesion  as  by  a  disturbance  of  its  nervous  regulating  mechanism. 

From  a  physiological  viewpoint  I  reiterate,  therefore,  the  unity 
of  the  Basedovian  syndrome  in  its  divers  clinical  modalities.^^® 

The  cases  due  to  thyroidal  lesions  are  certain.  I  argue  no  more. 
The  cases  due  to  nervous  disorders  appear  no  less  often. 

Curschmann^^^  has  seen  in  a  woman  tabetic  an  intermittent  Base- 

^^*  Laignel-Lavastine  et  Viard,  Adipose  segmentaire  des  membres  in- 
férieure, Soc.  de  Neurol.,  11  juill.,  1912;  Nouv.  Iconographie  de  la  Salpétrière, 
1912,  No.  6. 

115  G.  Roussy  et  J.  Clunet,  Les  les  du  Corps  thyroide  dans  la  mal  de 
Basedow,  Annales  de  med.,  t.  i,  No.  4,  avril,  1914,  pp.  395-438. 

11^  E.  Gley  et  Cleret,  Recherches  sur  la  pathogenic  du  goitre  exoph- 
thalmique,  J.  de  Physiol,  et  de  Pathol,  gen.,  191 1,  p.  928,  et  Cleret,  These, 
1912. 

ii'^  Laignel-Lavastine  et  Bloch,  Syndrome  de  Basedow  chez  une  tuber- 
culeuse. Arch.  gen.  de  med.,  sept,  1904,  pp.  2456-61. 

lis  L'épreuve  de  l'hypophyse  (ralentissement  du  pouls  chez  les  Base- 
dowiens,  découverte  par  Claude  et  ses  élevés  (Soc.  de  med,  des  hop.,  19  juin, 
1914)  permet  de  limiter,  dans  le  même  esprit,  le  syndrome  de  Basedow. 

11®  Curschmann,  Sur  des  symptômes  basedowiens  intermittents  (dans  les 
tabes  et  l'asthme  bronchique).  Zeitschrift  f.  klinische  medizin,  1912,  LXXVI, 
3-4. 


THE    NERVOUS   SYSTEM 


45 


dovian  syndrome  coincident  with  gastric  crises.  He  saw  in  this  a 
sympathicotonic  sign,  and  he  was  not  far  from  siding  with  the  opin- 
ion of  Morat  and  Abadie,  who  saw  in  the  lesion  of  the  thoracic 
sympathetic  the  starting  point  of  the  Basedovian  syndrome. 

The  beneficial  influence  exercised  by  adrenalin  on  the  crises  is 
to  be  noted. 

This  fact  is  contrary  to  the  theory  of  Gottlieb-O'Connor,  ac- 
cording to  which  the  thyroidal  secretion  sensitizes  the  terminal 
organs  of  the  sympathetic. 

It  is  explained  on  the  other  hand  by  the  researches  of  Elliot  and 
Durham,  who  established  the  fact  that  after  an  injection  of  ad- 
renalin excitation  of  the  splanchnic  nerve  caused  a  lowering  of  the 
blood  pressure  instead  of  the  normal  elevation,  and  this  exists  also 
in  gastric  crises. 

Being  more  synthetic  than  analytic,  looking  at  things  physio- 
logically and  not  anatomically  or  etiologically,  I  conclude  that  the 
Basedovian  syndrome  in  its  fundamental  mechanism  is  an  endocrino- 
sympathetic  syndrome,  whose  divers  clinical  types  arise  from  various 
lesions,  at  times  endocrinal  (always  thyroidal,  sometimes  thymic, 
ovarian,  parathyroidal,  etc.),  at  others  nervous  (cervical  or  bulbar 
sympathetic)  under  the  dominance  of  intoxications  or  infections 
acute  or  chronic,  either  general  or  local,  of  which  the  most  frequent 
are  acute  articular  rheumatism  and  tuberculosis. 

(2)  Addison's  Syndrome 

Thus  from  a  case  of  Addison's  syndrome  without  appreciable 
gross  lesions  of  the  suprarenals  (1899)  I  wrote  my  thesis^^**  in  an 
endeavor  to  demonstrate  that  there  were  Addisonians  in  whom  noth- 
ing was  to  be  seen  except  lesions  of  the  sympathetic,  in  whom  the 
suprarenal  disturbances  were  secondary  to  nervous  changes,  and  who 
showed  all  the  intermediary  signs  of  the  melanodermic^^^  tuberculosis. 
To  the  anatomical  theory  of  the  Addisonian  discoloration  I  put  in 
opposition  a  more  comprehensive  physiological  theory  and  to  the 
lesional  contingency  the  functional  necessity. 

The  recent  observation  of  N.  Pende  and  Varvaro^--  came  to  the 
support  of  this  point  of  view.  They  have  seen  in  a  man  of  thirty- 
six  years  of  age  an  Addisonian  syndrome  secondary  to  a  rapid  pul- 
monary tuberculosis.  At  autopsy  the  suprarenals  were  normal  in 
their  make-up.  In  the  cortex  the  spongiocytes  were  rare,  and  pig- 
ment was  almost  completely  lacking  in  the  reticular  zone. 

'20  Laignel-Lavastine,  Recherches  sur  le  plexus  solaire,  Thèse,  1903. 
p.  420. 

121  Laignel-Lavastine,  La  mélanodermie  des  tuberculeux,  Soc.  méd.  des 
hôp.,  29  janv.,  1904,  et  Arch.  gén.  de  méd.,  oct.,  1904,  pp.  2497-2520. 


46  THE   INTERNAL   SECRETIONS   AND 

At  the  level  of  the  solar  plexus  there  were  two  aberrant  supra- 
renals  of  normal  structure.  The  ganglia  of  the  solar  plexus  were 
free  from  tuberculous  lesions,  but  they  were  of  notable  size,  and  ex- 
amined histologically  they  appeared  poor  in  sympathetic  nerve  cells 
and  rich  in  new-formed  connective  tissue.  The  nervous  elements 
still  seen  presented  pigmentary  atrophy. 

To-day  one  differentiates  the  primitive  Addisonian  syndrome  of 
slow  and  progressive  evolution  from  the  secondary  Addisonian  syn- 
drome, which  is  seen  in  the  already  more  or  less  advanced  tuber- 
culous cases,  and  which  has  a  less  clearly  defined  symptomatology. 

Pende  and  Varvaro  think  that  in  the  first  case  the  anatomical 
substratum  has  its  seat  in  the  suprarenal,  and  in  the  second  in  the 
region  of  the  solar  plexus.  Their  reported  case  is  a  type  of  the 
secondary  Addisonian  syndrome. 

Porak  and  myself  have  observed  a  case  which  anatomo-clinically 
was  quite  similar. 

Thinking  physiologically^^^  one  can  conclude  that  the  Addisonian 
syndrome  is  the  expression  of  a  certain  degree  of  chronic  suprarenal 
insufficiency  with  a  disturbance  of  adreno-sympathetic  pigmentary 
regulation. 

In  this  adreno-sympathetic  syndrome  one  can  differentiate  two 
anatomo-clinical  forms  :  one  form  with  predominance  of  the  supra- 
renal lesions,  it  is  the  most  frequent,  and  in  general  is  clinically 
primitive,  the  second  form  with  predominance  of  the  sympathetic, 
periadrenal,  solar  or  splanchnic  lesions.  It  is  less  frequent,  often 
fruste,  and  in  general  is  clinically  secondary  to  a  pulmonary  pthisis. 

(3)  Scleroderma 

The  absence  of  the  thyroidal  sign  of  Vincent  in  acute  articular 
rheumatisms  followed  at  first  by  Basedow's  syndrome,  and  later  on 
by  evidences  of  thyroidal  atrophy  with  the  appearance  of  sclero- 
derma, which  sometimes  is  apparently  arrested  by  thyroidal  medica- 
tion, has  caused  a  belief  in  the  existence  of  a  scleroderma  due  to 
thyroidal  disturbances  of  rheumatic  origin. 

This  endocrinogenic  form  of  scleroderma  is  not  to  be  ques- 
tioned.   It  is  quite  possible  that  it  is  not  the  only  one,  and  that  other 

122  N.  Pende  et  Varvaro  (de  Palermo),  Maladie  d'Addison  avec  in- 
tégrité apparente  des  glandes  surrénales  et  avec  hypertrophie  des  glandes 
surrénales  accessoires,  La  Riforma  medica,  Nos.  40  et  41,  4  et  il  cet.,  1913, 
pp.  1093  et  1124. 

123  La  communication  récente  de  Hirtz  and  Debre  (Addisonien  observe 
en  1902  considère  comme  guéri,  retrouve  en  1913,  autopsie),  a  la  Soc.  med. 
des  hop.,  le  26  juin,  1914,  et  la  discussion  que  suivit  entre  L.  Bernard,  Netter 
et  Sergent  (3  juillet,  1914,  p.  20),  ne  contredisent  pas  mes  conclusions. — Voir 
de  plus  Fayolle,  Thèse,  2  juillet,  1914. 


THE    NERVOUS   SYSTEM  47 

endocrinal  disturbances  are  capable  of  producing  scleroderma  or  add 
their  action  to  that  of  the  thyroid^24  j^  its  causation. 

In  addition,  in  spite  of  Touchard,^^^  it  seems  very  difficult  to  do 
away  with  a  sympathetic  factor  in  certain  cases. 

Referring  to  an  association  of  Basedow's  syndrome  and  sclero- 
derma, G.  Marinesco  and  Goldstein^^®  say  that  it  is  "evident  that 
the  sclerodermic  syndrome  does  not  depend  entirely  on  a  disturbance 
of  thyroidal  function,  but  that  this  disturbance  exercises  a  certain 
action  on  the  sympathetic  system,  and  brings  about  in  this  way  the 
appearance  of  the  scleroderma."  There  are  cases,  as  they  say,  which 
confirm  all  the  pathogenetic  theories  :  the  trophoneurotic,  the  angio- 
trophoneurotic,  the  sympathetic,  the  vascular,  the  pituitary,  the  thy- 
roidal and  the  pluriglandular.  However  none  of  these  theories  can 
be  applied  to  these  cases  as  a  whole. 

Gauthier^^^  distinguishes  two  forms  of  scleroderma,  the  ordinary, 
depending  upon  hyperthyroidism,  and  a  special  type,  with  a  less 
parchment-like  skin  and  having  subcutaneous  fat,  depending  upon 
hypothyroidism. 

Cassirer^-^  puts  in  the  list  of  the  vegetative  syndromes  the  vaso- 
motor and  trophic  neurosis,  among  which  he  classifies  scleroderma. 

Marinesco  and  Goldstein  consider  that  the  thyroidal  secretion 
acts  in  the  cases  accompanied  by  Basedovian  symptoms,  as  well  as 
in  those  with  other  thyroidal  manifestations,  through  the  sympa- 
thicotrope  action  of  that  secretion. 

The  connections  and  even  the  associations  of  certain  sclerodermas 
with  Basedovian  and  Addisonian  syndromes  compel  me  to  admit 
that  if  in  the  first  place  scleroderma  is  an  endocrinal  syndrome,  it  is 
also  sometimes  a  vegetative  syndrome,  and  that  consequently  it  has 
the  right  to  be  quoted  among  the  group  of  endocrino-sympathetic 
syndromes. 

(4)  Diabetes  Mellitus 

Diabetes  arises  from  a  disorder  in  the  regulating  mechanism  of 
the  sugar  function.  Glycosuria,  the  most  frequent  disorder  of  this 
function,  is  at  first  heading  an  endocrino-sympathetic  syndrome. 

^2*  Voir  à  l'appui  :  Laignel-Lavastine,  Sclerodermic  mélanodermique, 
Soc.  med.  des  hop.,  31  janvier,  1908;  Dupré  et  P.  Kahn,  Sclérodermie  et  mal.  de 
Raynaud,  Soc.  méd.  des  hop.,  11  juin,  1909;  Chantemesse  et  Coureoux,  Scléro- 
dermie avec  atrophie  thyroïdienne  et  mélanodcrmie,  Soc.  méd.  des  hôp.,  3 
juin.,  1914. 

^25  Touchard,  Thèse,  1906. 

^2«  Marinesco  et  Goldstein,  Syndrome  de  Basedow  et  Sclérodermie,  Nouv. 
Iconographie  de  la  Salp.,  juill.-aout.,  1913,  pp.  272-290. 

i2î  Ch.  Gauthier,  Fonct.  du  corps  thyroïde,  R.  de  Méd.,  1900,  p.  442. 

*28  Cassirer,  Die  vasomotorich-trophischcn  Ncurosen,  2°  éd.,  1912,  pp. 
536-700. 


48  THE   INTERNAL   SECRETIONS   AND 

Without  going  into  the  secretion  of  sugar  by  the  liver,  which  was 
the  first  internal  secretion  known,  or  into  the  influence  of  the  in- 
ternal secretions  of  the  pancreas  on  sugar  metabolism,  it  suffices  to 
mention  adrenalin  glycosuria  as  well  as  suprarenal  diabetes  to  show 
the  existence  of  glycosuria  of  endocrinal  origin. 

In  addition  McLeod,  after  Cavazzini,  has  laid  stress  on  the  gly- 
cosuria following  excitation  of  the  great  splanchnic  and  on  the  fact 
that  puncture  of  the  bulb  in  the  normal  dog  is  without  efïect  after 
section  of  the  splanchnic  nerves. 

There  is  need  therefore  of  a  sympathetic  factor  in  the  production 
of  certain  glycosurias. 

Finally  in  the  decapsulated  dog  puncture  of  the  fourth  ventricle 
(Mayer),  as  well  as  stimulation  of  the  splanchnic  (Gautrelet  and 
Thomas),  does  not  produce  glycosuria.  This  proves  the  need  of  a 
double  endocrino-sympathetic  factor  in  certain  glycosurias. 

One  can  conceive,  therefore,  the  possibility  of  diabetic  cases, 
endocrino-sympathetic  syndromes,  in  which  sometimes  either  the 
endocrinal  factor  or  the  sympathetic  factor  seems  to  predominate. 

3.  Psycho-neuroses 

I  indicated  in  1908  the  importance  of  endocrine  disorders  in  the 
psycho-neuroses.  Facts  published  since  then  in  the  literature  and 
my  personal  practice  have  confirmed  me  in  my  opinion.  One  part 
of  functional  neurology  comes  under  the  heading  of  endocrino-neu- 
rology  to-day. 

This  subject  will  be  found  worthy  of  great  elucidation.  I  can 
not  go  into  it  here,  and  will  say  but  a  word  regarding  endocrine  dis- 
orders among  the  "nervous,"  the  neurasthenics,  the  hysterics,  the 
psychasthenics  and  the  epileptics. 

(i)  Nervousness 

It  will  be  interesting  clinically,  said  I  in  1908,  not  to  stop  at  a 
simple  sémiologie  diagnosis  in  the  presence  of  a  neurosis,  but  to  in- 
quire into  the  reasons  for  the  irritable  weakness  of  the  nervous  sys- 
tem in  the  general  functionating  of  the  organism,  and  from  this  point 
of  view  not  to  neglect  the  examination  of  the  internal  secretions. 

The  Viennese  School,  especially  Eppinger  and  Hess,^^^  in  the 
neurosis  of  Oppenheim,  have  distinguished  the  two  clinical  types  of 
vagotonics  and  sympathicotonics,  the  relationships  of  which  they 

1-9  H.  Eppinger  et  L.  Hess,  Die  Vagotonie,  Sammlung  klinischer  Abhand- 
lungen  iiber  Pathol,  u.  Therap.  der  Stoffwechsel  u.  Ernàhrungsstôrungen,  f. 
9-10,  Berlin,  1910.     Tr.  Kraus  and  Jelliffe,  Neurological  Monographs. 


THE   NERVOUS   SYSTEM  49 

have  striven  to  connect  with  such  and  such  disturbances  of  internal 
secretion.  Their  remarkable  description  of  vagotonics,  which  is 
classic  to-day,  has  been  translated  or  recapitulated  in  all  languages. 
I  refer  you  to  these  works.^^° 

Before  that  Leopold  Levi  and  H.  de  Rothschild^"^  had  prepared 
the  way  with  their  excellent  study  on  thyroidal  neuroses. 

In  a  number  of  cases  the  clinical  types  of  neuroses,  such  as  the 
vaso-motor  habitus  of  Savini^^^  or  the  emotional  constitution  of 
Dupré,^^^  come  under  the  heading  of  thyroidal  neuroses,  and  from 
a  diagnostic  standpoint  the  joining  of  a  simple  clinical  type  to  an 
endocrino-nervous  syndrome  is  a  step  forward,  because  one  enters  a 
little  further  into  the  understanding  of  the  morbid  mechanism. 

Moreover  a  good  many  vagotonics,  like  a  good  many  sympathico- 
tonics, also  come  under  the  heading  of  dyshyperthyroidal  neuroses, 
and  these  different  effects  arising  from  the  same  endocrine  disorder 
— supposing  that  it  always  is  the  same — should  not  cause  amazement. 

They  are  on  the  same  order  as  the  facts  which  were  noted  by 
Asher  and  de  Rodt^^*  in  their  experiments  on  the  thyroidal  secre- 
tions. According  to  the  individual  peculiarities  of  the  animals,  it 
was  sometimes  the  action  on  the  vagus  and  sometimes  the  action  on 
the  sympathetic  that  predominated.  In  addition  the  effect  of  an 
injection  of  thyroidal  extracts  depended  in  great  measure  on  the 
degree  of  excitability  of  the  nerves  of  the  animal  experimented 
upon. 

This  observation  seemed  to  me  as  being  of  extreme  importance 
and  of  a  general  application.  In  pointing  out  more  or  less  marked 
reactional  phenomena  in  the  nervous  system  as  being  hand  in  hand 
with  certain  secretions  with  which  they  are  for  the  moment  more 
or  less  in  accord,  evidence  is  given  of  the  dangers  of  too  hasty  in- 
ductions relative  to  the  action  of  the  endocrine  secretions  on  the 
separate  parts  of  the  nervous  system  and  to  their  specific  elective 
action,  which  are  to  a  certain  extent  antagonistic. 

There  are  not  only  thyroidal  neuroses  allied  with  all  the  modali- 
ties of  stimulation  or  insufficiency  of  thyroidal  secretion,  but  dis- 

^"°  Cheinisse,  Sem.  méd.,  20  nov.,  1912,  pp.  553-556;  W.  M.  Kraus  et  S. 
E.  JelliflFe,  J.  of  Nerv.  and  Ment.  Disease,  mars,  avril,  mai,  1914,  p.  164. 

^•■'1  Leopold  Levi  et  H.  de  Rothschild,  Etude  sur  le  corps  thyroïdien. 

^32  E.  Savini,  Le  type  constitutionnel  sympathique  ou  vaso-motor.  Progrès 
médical,  15  fév.,  1913,  pp.  82-85. 

^•■2  E.  Dupré,  La  constitution  émotive,  Paris  méd.,  7  oct,  191 1,  p.  404. 

^'*  L.  Asher  et  M.  de  Rodt,  Innervât,  des  gl.  à  secret,  int.  et  act  des 
produits  de  secret,  int.  sur  le  syst.  nerv.,  Soc.  suisse  de  Neurol.,  11-12 
nov.,  iQii, 

Rcv   méd.  de  la  Suisse  romande,  XXXII,  No.  2,  p.  183,  20  fév.,  1912. 


50  THE   INTERNAL   SECRETIONS   AND 

turbances  of  the  ovaries,  testicles,  suprarenals  and  the  pituitary  may 
be  the  origin  of  beginning  neuroses. 

This  idea  of  an  attempt  to  discover  the  endocrinal  disturbance 
before  the  neurosis  becomes  sufficiently  marked  to  be  morbid  allow- 
one  perhaps  to  restore  an  equiUbrium  to  these  nervous  tempera- 
ments through  an  organotherapy,  which  is  to  a  certain  extent 
prophylactic. 

They  are  helped  in  this  way  before,  to  use  a  vulgarism,  they 
have  had  a  chance  to  get  the  habit  of  the  disease. 

Finally  among  "  the  nervous  "  endocrine  disorders  may  be  in 
their  turn  secondary  to  nervous  disturbances.  These  secondary 
neurogenous  endocrinal  symptoms  must  not  be  confounded  with 
primitive  endocrine  disorders — the  causes  of  the  nervous  disorders. 
This  intricacy  is  common  among  the  hyposphyxics  of  Martinet;  I 
have  under  observation  at  the  present  time  a  nervous  woman  with 
hyposphyxia  and  hypothyroidism,  whose  extremely  low  arterial 
tension  is  improved  more  by  small  doses  of  thyroid  than  by  supra- 
renal, and  I  believe  that  it  is  through  a  nervous  influence  that  the 
thyroidal  insufficiency  of  scarlatinal  origin  reacts  upon  the  supra- 
renal. 

After  what  I  have  said  concerning  endocrinogenic  asthenias 
I  will  be  very  brief  as  regards  neurasthenia  of  endocrinal  origin. 
Since  attaching  the  importance  to  it  that  I  did  in  1908,  I  have 
searched  for  it  regularly  in  my  practice,  and  have  often  found  it. 
The  forms  connected  with  adrenal  and  genital  insufficiency  (dia- 
stematic  and  prostatic)  seem  to  me  to  predominate  in  the  male,  and 
the  forms  connected  with  ovarian  and  thyroidaP^^  insufficiency  to 
predominate  in  the  female.  Certain  neurasthenias  of  infectious 
origin,  such  as  the  tuberculous,  syphilitic,  and  gonorrheal,  result  as 
much  if  not  more  from  the  endocrinal  insufficiency  caused  by  the 
microbes  than  from  the  toxines  produced  by  them  directly. 

These  endocrine  disorders  which  cause  neurasthenia  must  not 
be  confounded  with  the  secondary  neurogenous  endocrinal  symp- 
toms, which  are  often  seen  in  neurasthenias,  and  which  bear  mostly 
on  the  vegetative  nervous  system. 

The  two  disorders — endocrinogenic  neurotic  and  neurogenic 
endocrinal — often  coexist,  and  by  their  intricacy  complicate  the 
clinical  picture.  The  analysis  can  be  gotten  at  through  the  thera- 
peutic results. 

''■■'•^  Allen  Starr,  Neuroses  depend  upon  errors  of  inter,  secret,  of  the 
ductless  glands,  Med.  Record,  20  juin,  1912. 


the  nervous  system  5 1 

(3)  Hysteria 

Hysteria,  whatever  the  idea  may  be  that  one  holds  in  regard 
to  it,"^  is  observed  among  "the  nervous." 

I  have  shown  the  frequency  of  neuroses  of  endocrinal  origin. 
I  beheve  that  I  can  class  the  disorders  of  internal  secretion  among 
the  predisposing  causes  of  hysteria  through  the  intermediary  of 
nervosity.  As  a  matter  of  fact  I  have  often  found  endocrinal  dis- 
turbances, especially  of  the  thyroidal  or  ovarian  type,  among 
hysterics, 

(4)  Psychasthenia"^ 

Etymologically  psychasthenics  should  be  classed  among  the 
neurasthenics  in  whom  the  asthenia  bears  especially  on  the  psychic 

sphere. 

But  following  along  with  Raymond  and  Janet  we  class  espe- 
cially as  psychasthenics  those  who,  on  the  whole,  are  obsessed. 

When  one  follows  these  cases  one  sees  that  their  paroxysmal 
blustering  syndromes  are  nothing  but  the  morbid  oflfshoots  of  deeper 
variations  of  nervous  tonus  or  psychic  tone.  These  changes  in 
women  are  nearly  always  connected  with  the  sexual  life.  In  man 
one  finds  them  running  parallel  with  such  symptoms  as  headache,  in- 
somnia, hyper-  or  hypotension,  tachycardia  and  constipation,  which 
frequently  can  be  connected  with  endocrinal  disorders. 

Thus  among  the  predisposed,  obsessions,  which  might  be  re- 
garded as  a  mental  autonomic  syndrome,  are  often  nothing  but  the 
psychic  expression  of  a  more  or  less  difïuse  anxiety  which  in  itself 
is  the  result  of  a  disturbance  of  the  sympathetic  system  of  endo- 
crinal origin.  Thyroidal  excitation  particularly,  by  increasing  the 
irritability  of  the  peripheral  sympathetic  centers  which  it  controls, 
predisposes  to  these  dissociations  of  personality.  The  thyroid,  so 
to  speak,  is  an  anarchistic  emancipator. 

Be  that  as  it  may,  the  variations  in  nervous  and  psychic  tone 
thus  determined  may  react  secondarily  on  all  the  vegetative  func- 
tions not  forgetting  the  ductless  glands,  and  can  thus  establish  a 
vicious  circle. 

(5)  Epilepsy 
It  is  always  wise  in  the  diagnosis  of  an  epilepsy  after  becoming 
advised  as  to  the  causes  explaining  the  cortical  changes  to  pass  in 

i3«  Laignel-Lavastine,  Les  réactions  anti-sociales  des  hystériques,   Paris 

Médical.  30  mai,  1914.  ^   .  ,  t    u  .  1  •    c     t? 

'"Schnyder,  L.,  R.  méd.  de  Suisse  romande,  oct.,  1913;  Lubetzki,  b.,  K. 

de  méd.,  août,  10^3- 


52 


THE   INTERNAL   SECRETIONS   AND 


review  the  reasons  for  the  organic  poisoning  and  among  these  not 
to  overlook  the  glandular  disturbances.  The  search  for  the  minute 
signs  of  these  disturbances  may  thus  institute  the  use  of  one  glan- 
dular therapy  rather  than  another.  It  is  most  often  the  thyroidal 
disturbances  that  are  revealed  in  endocrinal  disorders  among  epi- 
leptics. 

Many  subsequent  works^^^  have  confirmed  this  conclusion  in  my 
report  of  1908. 

Sometimes  they  are  hypothyroideal  in  type  and  sometimes 
dyshyperthyroideal.  This  is  not  contradictory.  The  endocrinal  dis- 
order, according  to  the  statement  of  Leopold  Levi,  "  is  the  patho- 
logical mordant  that  sensitizes  centers  already  predisposed."  The 
endocrinolepsy,^^^  whatever  form  the  crisis  may  take,  is  set  free  by 
a  complete  rupture  of  the  endocrinal  equilibriimi.  The  incidental 
causes  alone  are  different.  Thus  in  a  still  unpublished  lecture"* 
on  the  thyroid  body  and  epilepsy  pertaining  to  a  confusional  epileptic 
stupor  seen  in  a  tuberculous  heredo-alcoholic  Basedovion,  I  showed 
that  the  crisis  coincided  with  and  followed  her  menstrual  periods, 
while  with  her  hypothyroidal  sister  they  preceded  them  as  a  rule, 
and  were  absent  during  pregnancy. 

In  the  epileptic  seizures  of  thyroidal  origin,  therefore,  I  wish  to 
differentiate  the  dyshypothy  roi  deal  crises  from  the  dyshyperthy- 
roideal^*^ crises;  these  latter  discharges  moreover  possibly  surviv- 
ing in  all  three  forms  of  thyroidal  instability. 

4.  Temperaments 

Temperament,  as  I  said  at  Dijon  in  1908,  is  the  dynamic  char- 
acteristic of  the  organism,  just  as  constitution  is  the  static  character- 
istic. Following  this  conception  of  Professors  Bouchard,  Landouzy 
and  Roger  it  can  be  stated  that  what  one  is  to  physiology  the  other 
is  to  anatomy.     Now  it  appears  to  me  that  among  the  various  innc- 

138  Sicard,  Journ.  de  med.  de  Paris,  1912;  Gelma,  Rev.  de  med.,  10  janv., 

1913,  PP-  26-39.  Guilton,  Contrib.  à  l'ét  des  symp.  épileptiques  dans  les  états 
thyroïdiens,  Th.,  Montpellier,  1913,  No.  58;  Enzière  et  Margarot,  Soc.  de  se. 
méd.  de  Montpellier,  2  mai,  1913;  Silvestri,  Opothérapie  surréno-médull.  et 
épilepsie.  Il  Policlinico,  29  juin,  1913,  pp.  917-922;  Dufour  et  Legros,  Syn- 
drome hypo-ovarien  et  hypo-thyroïdien.  Crises  épileptif ormes  (vagotonic). 
Soc.  méd.  des  hôp.,  27  mars,  1914;  Bolten  G.,  Monatsch.  f.  Psych.  u.  Neurol., 
33,  No.  2,  fév.,  1913;  Claude  et  Schmiergeld,  Encéph.,  10  janv.,  1909. 

13»  Leopold  Levi,  Les  endocrinolepsies,  Soc.  de  méd.  de  Paris,  9  janv., 

1914,  p.  44; 

i**'  Laignel-Lavastine,  Clinique  psychiatrique,  22  mars,  1914. 
1*1  Ces  crises  me  paraissent  vraiment  rythmées  par  les  règles  quoi  q'en 
disent  Toulouse  et  Marchand  (R.  de  Psychiatrie,  mai,  1913). 


THE   NERVOUS   SYSTEM  53 

tions,  the  individual  varieties  of  which  have  to  do  with  tempera- 
ments, those  of  the  internal  secretions  should  not  be  neglected,  and 
when  one  decides  to  take  up  the  long-forsaken  study  of  tempera- 
ments in  accordance  with  the  classical  types — the  sanguinary,  the 
nervous,  the  lymphatic  and  the  bilious,  one  might  discern  perhaps 
the  thyroidal,  the  pituitary,  the  adrenal,  the  ovarian  and  dias- 
thematic,  etc. 

This  view  of  the  question  is  but  the  application  to  the  internal 
secretions  in  relation  to  temperament,  of  the  masterly  conception  of 
Prof.  Charles  Richet  expressed  at  the  Congress  of  Vienna  in  1910: 
"  We  are  as  yet  but  at  the  portal  of  that  chemistry  of  the  imponder- 
able, founded  on  the  analysis  of  biological  functions,  and  although 
we  can  already  foresee  some  of  the  results,  we  are  soon  led  into  a 
region  in  the  study  of  the  physiology  of  the  individual,  which  until 
to-day  was  almost  unexplored,"  that  physiology  which,  in  my  lecture 
at  the  opening  of  the  course  on  medico-legal  psychiatry  in  1910,  I 
called  the  differential  psychology,  and  I  linked  diflferential  psychol- 
ogy with  the  knowledge  of  character  and  differential  anatomy  with 
the  knowledge  of  constitution. 

Since  then  the  idea  has  been  greatly  amplified,  and  Prof.  N. 
Pendé"^  has  allotted  a  chapter  to  it  in  his  remarkable  report  ot 
1912  on  the  internal  secretions.  As  a  clever  clinician  he  has  related 
the  constitutional  vascular  hypotonia  of  Ferrannini  with  the  thymo- 
lymphatic  state  of  Paltauf  or  the  asthenic  or  hypoplasic  constitu- 
tional state  characterized  by  hypoplasia  of  chromaffin  and  genital 
tissue  combined  with  hyperplasia  of  lymphatic  and  thymic  tissue. 

Then  again  he  believes  that  he  can  connect  the  vagotonia  of 
Eppinger  and  Hess  with  the  exudative  diathesis  of  Czerny. 

He  considers  the  lymphatic  and  thymo-lymphatic  states  to  which 
he  adjoins  the  chlorotic  state  as  an  organic  immaturity  of  the  endo- 
crinal  system  in  its  chromaffin  and  genital  parts  contrasting  with 
excessive  development  in  the  same  system  of  its  lymphatic  and 
thymic  parts.  He  recalls  the  antithesis  established  by  Viola  between 
the  apoplectic  or  short  or  megalosplanchnic  habitus  with  the  phthis- 
ical or  long  or  microsplanchnic  habitus.  He  adds  that  very  fre- 
quently hypothyroidea  coincides  with  the  megalosplanchnic  habitus 
and  hyperthyroidea  with  the  microsplanchnic.     Remarking  also  that 

^■•2  Rapin,  Angioneuroses  familiales,  R.  med.  de  la  Suisse  romande,  1907, 
p.  196. — G.  Maranon,  R.  de  med.,  mars,  1914,  p.  180. — Falta,  loc.  cit.,  p.  39. — 
Leopold  Levi,  Families  thyroïdiennes  et  dysendocriniennes- 

^♦^  N.  Pcndé,  Le  secrezioni  interne  nei  rapporte  con  la  clinica  XXII* 
Congresso  di  Medicina  Interna  in  Roma,  oct.,  1912. 


54  THE   INTERNAL   SECRETIONS   AND 

he  has  often  seen  signs  of  vagotonia  among  the  megalosplanchnics 
and  of  sympathicotonia  among  microsplanchnics  he  deducts  this 
double  equation  :  vagotonia-megalosplanchnia-hypothyroidea  ;  sym- 
pathicotonia-microsplanchnia-hyperthyroidea. 

Pende  very  prudently  does  not  advance  these  considerations 
except  as  a  means  of  indicating  the  road  to  follow,  and  in  fact  this 
classification  seems  to  me  to  err  through  too  great  a  desire  for  sym- 
metry and  by  too  static  a  conception  of  the  notions  regarding  vago- 
tonia and  sympathicotonia. 

These  predominances  as  a  rule  only  express  the  evolutional  mo- 
ments of  the  individual.  Thus  when  asleep  at  night  we  are  all 
vagotonics.  The  adult  and  the  aged  differ  more  from  the  child 
than  the  sleeping  man  from  the  awakened.  Their  vegetative 
nervous  formula  has  therefore  the  chance  of  not  remaining  the  same 
all  during  life. 

If  I  criticize  the  too  sharply  drawn  lines  of  the  theoretical  elucida- 
tion I  share,  as  I  have  already  said,  in  the  directing  idea.  It  is 
moreover  essentially  French.  Leopold  Levi  and  H.  de  Rothschild 
have  been  the  first  to  deserve  the  credit  for  connecting  the  classical 
neuro-arthritic  diathesis  with  hyperthyroidism.^**  It  is  true  that 
prior  to  that  time  Hertoghe  classed  adenoid  cases  as  among  the 
hypothyroidal,  and  opened  the  way  for  the  classification  of  many 
lymphatic  temperaments  among  cases  of  hypothyroidism. 

Another  step  along  the  trail  brings  us  to  the  diatheses  of  Bazin — 
a  masterly  conception  and  a  very  true  one,  which  the  fancies  of  the 
pastoral  era  had  caused  to  be  forgotten,  but  to  which  we  bring  back 
the  analysis  of  temperament  in  the  light  of  endocrinology. 

Finally  I  must  recall  that  Lancereaux,  when  he  saw  in  the 
sympathetic  the  principal  factor  in  herpetism,  had  in  advance  the 
intuition  of  the  ties  which  unite  endocrino-sympathetic  disturbances 
with  temperaments. 

To-day  I  believe  it  possible  to  enlarge  and  clarify  the  question  a 
little,  thanks  to  what  I  have  called,  in  a  clinical  lecture,  the  endo- 
crino-diagnosis  of  temperaments;  an  endocrino-diagnosis  which 
must  be  worked  out  according  to  the  method  of  glandular  tests  of 
Claude  and  his  pupils,  and  which  will  allow  one  to  depict  a  series 
of  types.  This  series  of  types  will  depend  on  thyroidal  or  ovarian 
or  testicular  or  pituitary  or  suprarenal  temperaments  more  or  less 
clearly  defined,  according  to  the  more  or  less  marked  predominance 
of  one  or  of  several  of  the  glands  of  internal  secretion  in  the  endo- 

1**  Leopold  Levi,  Neuro-arthitisme  et  gl.  endocrines,  Mouv.  méd.,  mai, 
1913- 


THE    NERVOUS   SYSTEM 


55 


crinal  equilibrium.     I  expect  to  publish  in  the  near  future  a  de- 
scription along  these  lines  of  the  principal  temperaments. 

5.  Character"^ 

Character,  to  my  mind,  as  I  said  in  1908,  is  nothing  but  the 
psychological  expression  of  temperament.  Constitution,  tempera- 
ment, character  are  thus  but  three  expressions— anatomical,  physio- 
logical and  psychological— of  the  reactional  coefficient  of  the  in- 
dividual. 

"The  importance  of  individual  varieties  of  internal  secretions 
will  be  seen  again  therefore  in  characters.  The  laity  have  long 
spoken  of  good  or  bad  humor  in  their  spontaneous  psychology  and 
also  of  humor  in  medical  parlance.  This  identity  of  terminology 
seems  to  me  to  conceal  a  profound  meaning,  which  the  study  of 
the  internal  secretions  uncovers.  These  secretions  by  their  varia- 
tions react  on  the  mental  life  as  well  as  on  the  rest  of  the  organism, 
and  manifest  themselves  at  first  and  above  all  by  changes  of  humor, 
modifications  of  aflfective  life,  because  the  latter  rather  than  motor 
or  especially  intellectual  activity  depends  on  organic  life  from 
which  it  can  scarcely  be  separated. 

For  a  long  time  my  observations  have  done  nothing  but  confirm 
me  in  my  opinions.  The  choleric  are  such  only  through  the  thy- 
roidal temperament,  just  as  the  lazy  are  such  only  through  supra- 
renal hypoplasia. 

Nevertheless,  even  if  an  endocrinal  factor  often  enters  into  the 
formation  of  character,  I  do  not  claim  that  it  always  does  so,  and 
many  other  elements  play  a  primordial  rôle  in  such  formation.  In 
addition  the  law  of  constancy  allows  the  establishment  of  rela- 
tionships between  morphological  and  psychological  series  which  are 
by  no  means  causal.  This  is  what  Bergson  has  caught  a  glimpse  of 
in  his  Creative  Evolution,  when  he  says  that  each  physiological  dis- 
position is  a  necessary  but  not  a  sufficient  condition  for  each  psychic 
state,  and  that  it  is  possible  to  have  many  psychic  states  from  the 
same  physiological  state  of  the  cerebral  gray  matter. 

Conclusions 

I.  From  a  morphological  standpoint  there  exist  clearly  defined 
connections  between  the  nervous  system  and  certain  glands  of  in- 
ternal secretion,  especially  between  the  sympathetic  and  the  chro- 
maffin systems. 

"=  Kollarits  Jeno,  Charakter  und  Nervositat,  Budapest,  1912. 


5'ô 


THE   INTERNAL   SECRETIONS   AND 


2.  From  a  physiological  standpoint  experimentation  has  shown 
that  stimulation  or  predetermined  sections  of  the  central  or  periph- 
eral nervous  system  modify  certain  internal  secretions  and  con- 
versely that  changes  produced  in  these  secretions  or  the  injection  of 
their  hormones,  where  such  are  known  and  isolated,  modify  the 
nervous  functions,  particularly  the  excitability  of  the  vegetative  sys- 
tem, with  predilection  sometimes  for  the  autonomic  and  sometimes 
for  the  sympathetic.  The  School  of  Vienna  deserves  the  credit  for 
having  shown  the  importance  of  these  elective  relations. 

3.  From  a  pathological  standpoint  much  less  is  known  as  yet 
than  one  would  suppose.  The  truth  of  the  endocrino-nervous  rela- 
tionships should  not  be  admitted  without  a  critical  analysis  bristling 
with  facts.    Nevertheless  it  can  be  said  that 

I.  Nervous  disorders  exist  due  to  disturbances  of  internal  secre- 
tion, and  disturbances  of  internal  secretion  exist  due  to  nervous  dis- 
orders. 

Endocrino-nervous  Relationships 


A. 
B. 
C. 


Coincidence. 

Association 

Causality 


•{ 


I.  Simple. 


1,  Proximate. 

2.  Mediate. 

'.  Endocrino-nervous. 
(i)  Direct. 

(2)  Indirect  through 
intermediary. 

.  Neuro-endocrine. 
(i)  Direct. 

(2)  Indirect  through  , 
intermediary. 


2.  Double 


...{ 


1.  Morphological  evolutional. 

2.  Morphological  humoral. 

3.  Physiological  humoral 

4.  Physiological  nervous. 

5.  Psychological. 


1.  Morphological  evolutional. 

2.  Physiological  reflex. 

3.  Psychological. 

4.  Motor  activity. 

5.  General  nutrition. 


Endocrino-neuro-endocrine. 
Neuro-endocrino-nervous. 


2.  The  two-fold  critical  analysis  of  the  neurological  and  par- 
ticularly the  endocrinological  methods  of  investigation  permits,  in 
the  midst  of  the  unknown,  the  redemption  of  certain  definite  rela- 
tionships between  the  endocrinal  and  the  nervous  disorders. 

3.  Until  more  ample  investigation  it  seems  to  me  that  these  rela- 
tionships might  be  expressed  in  the  following  table. 


In  practice  the  great  aid  that  endocrinology  brings  to  the  study 
of  neurology  and  especially  functional  neurology  manifests  itself 
particularly  in  the  clinical  study  of 


THE    NERVOUS   SYSTEM 


57 


1.  Ordinary  symptoms,  such  as  asthenia,  headaches,  insomnia,  anx- 

iety, sweats,  constipation,  arterial  hypertension  and  obesity. 

2.  Endocrino-sympathetic  syndromes,  such  as  Basedow's  syndrome, 

Addison's  syndrome,  scleroderma  and  diabetes  mellitus. 

3.  Psycho-neuroses. 

4.  Temperaments. 

5.  Characters. 

Endocrino-diagnosis  of  temperaments,  particularly  through 
glandular  tests  and  sympathico-vago-tonic  examinations,  in  pene- 
trating the  familial  heredity,  will  allow  us  to  use  prophylactic  meas- 
ures in  combating  diatheses  and  in  combating  certain  of  the  factors, 
the  humoral  and  neuro-vegetative  factors  for  instance,  which  are 
formative  of  character. 


INDEX 


ABDERHALDEN,  7 
Acrocyanosis,  28 
Acromegaly,  16-20 
Addison,  45 

Addison's  Syndrome,  15 
Anxiety,  29,  41 
Arterial  hypertension,  42 
Asthenia,  39 
Autonomic,  xi 

B 

BASEDOW,  12,  44 
Bony  Syndromes,  29 


Endocrinous-nervous  syndromes,  10 
Epilepsy,  26,  51 
Erythema,  28 
Erythromelalgia,  28 
Eunuchoid,  18 


FROEHLICH,  16 


GENITAL,  30 

Genito-suprarenal  syndrome,  15 
Glaucoma,  29 

Glands  of  internal  secretion,  2 
Giantism,  16 


CERVICAL  SYMPATHETIC, 

Character,  55 

Chinese  Organotherapy,  iii,  vii 

Choreas,  26 

Choroid,  17 

Circulation,  30 

Classical  syndrome,  11 

Conclusions,  55 

Constipation,  42 


Delirium,  32 
Dementia,  33 
Dermographia,  29 
Diabetes  hisipidus,  16 

mellitus,  47 
Digestur,  30 
Dioscorides,  viii 
Double  relationship,  xi 
Dyshyperdiastematosis,  18 
Dyshyperovaria,  19 

E 

ENDOCRINE  neurological,  38 
Endocrine  sympathetic,  44 
Endocrino-nervous,  23 


29 


H 


HEADACHE,  40 
Hydrocephalus,  17 
Hypertension,  42 
Hyperovaria,  17 
Hysteria,  51 


INFANTILISM,  17,  18 
Insomnia,  41 


LANGLEY,  xi 

M 

MACROGENITOSOMATOSIS,  17 
Methods  by  Examination,  4 
Melancholia,  29 
Migraine,  29 
Mitochondrea,  2 
Myasthenia,  14 

gross,  26 
Myexedema,  12 
Myoclonias,  26 
Myotonia,  26 


58 


INDEX 


59 


N 

NERVOUS  Endocrine,  37 

symptoms,  20 
Nervousness,  48 
Neurasthenia,  33 
Neuroglia  as  secretory,  2 
Neuropsychic,  33 


OBESITY,  43 
Oculocardiac  reflex,  xiii 
Organatlierapy  of  Ancients,  vii 
Organic  extracts,  7 
Ovarian  insufficiency,   17 
Ovary,  17 


RENON,  DELILLE,  16 
Respiration,  30 


SCLERODERMA,  46 

Sensory-motor  syndromes,  25 

Skin  Syndromes,  28 

Spasms,  26 

Sterile,  18 

Suprarenal  predominance,  20 

Suprarenals,  15 

Sweating,  4 

Sympathetic,  xi 

Sympathetic-endocrine,  44 

Sympathicotonic,  i 


PANCREAS,  16 

Paraganglia,  15 

Paralysis  Agitans,  14 

Paraplegia,  26 

Parathyroid,  14 

Parkinson's  Si'ndrome,  14 

Periodic  paralysis,  26 

Pineal,  17 

adiposity,  17 

Pituitary,  16 

Pharmacodynamic  tests,  xii 
Pharmacodynamics,  24 
Phobias,  23 

Physiological  method,  8 
Pluriglandular  period,  11 
Polyendocrine  Syndromes,  u 
Prostate,  18 
Psychasthenia,  51 
Psychic  Syndromes,  22 
Psychoendocrine,  34,  35 
Psychoneuroses,  48 


QUANTITATIVE  period,  10 


TEMPERAMENTS,  52 
Testicles,  18 
Tetany,  14 
Therapy,  9 

Thymopryvic  Idiocy,  15 
Thymus,  14 
Thyroid,  12 

Instability,  13 
Thyro-ovarian,  19 
Tremors,  26 
Trophic,  31 

U 

UNIENDOCRINE  syndromes,  12 
Urinary,  30 
Urticaria,  28 


VAGOTONIC.  I 
Vagotonic  Crises,  17 
Vegetative  System,  24 
Vertigoes,  26 


QP18T 

LlU 

1919     Laignel-Lavastine 

The  internal  secretions  and 
the  nervous  system. 


